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Results of Trimodality Therapy in Patients With Stage IIIA (N2-Bulky) and Stage IIIB Non–Small-Cell Lung Cancer
- Source :
- Clinical Lung Cancer. 10:353-359
- Publication Year :
- 2009
- Publisher :
- Elsevier BV, 2009.
-
Abstract
- Background The survival rates for stage IIIA and stage IIIB Non–Small-cell lung cancer (NSCLC) are extremely poor with single-treatment modalities such as radiation therapy or surgery. The purpose of this study is to assess tolerability, response, surgical resectability, and survival of chemotherapy followed by chemoradiation therapy, and then followed by surgery in patients with stage IIIA (N2-bulky) or stage IIIB NSCLC. Patients and Methods Forty-eight patients with stage IIIA (N2-bulky) or stage IIIB (T4 N1-2 M0) NSCLC received 2 cycles of chemotherapy with cisplatin, mitomycin, and vindesine, subsequent radiation therapy (45 Gy, twice-daily 1.5 Gy) with simultaneous low-dose cisplatin and vindesine, followed by surgery. Results Forty-five patients completed induction chemoradiation therapy. Thirty-three patients (68.8%) had clinical response to induction treatment. Thirty-nine patients underwent a thoracotomy, with a complete resection rate of 62.5% (30/48). The pathologic response rate was 60% (27/45), with complete pathologic response of 8 patients. The median survival time for the total group of 48 patients was 23 months, with 3- and 5-year survival rates of 41.7% and 31.8%, respectively. Multivariate analysis showed that complete resection and pathologic response in surgical specimens were independent predictors of survival ( P = .048 and P = .022). Conclusion Preoperative sequence of chemotherapy followed by concurrent chemoradiation therapy is an effective approach in patients with stage IIIA (N2-bulky) and IIIB (T4 N1-2 M0) NSCLC. The operation after induction chemoradiation therapy should be performed in carefully selected patients with surgically resectable diseases. The patients who achieved complete resection and with pathologic response of tumor can benefit from surgery following induction chemoradiation therapy.
- Subjects :
- Adult
Male
Pulmonary and Respiratory Medicine
Cancer Research
medicine.medical_specialty
Lung Neoplasms
Vindesine
Mitomycin
medicine.medical_treatment
Carcinoma, Non-Small-Cell Lung
Antineoplastic Combined Chemotherapy Protocols
medicine
Carcinoma
Humans
Thoracotomy
Lung cancer
Survival analysis
Aged
Neoplasm Staging
Chemotherapy
Radiotherapy
business.industry
Remission Induction
Middle Aged
medicine.disease
Combined Modality Therapy
Survival Analysis
Surgery
Radiation therapy
Treatment Outcome
Oncology
Tolerability
Disease Progression
Female
Cisplatin
business
medicine.drug
Subjects
Details
- ISSN :
- 15257304
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- Clinical Lung Cancer
- Accession number :
- edsair.doi.dedup.....63778f09f9b684b0d2070637bfbdd2d8