Enduring Challenge in the Treatment of Nonsmall Cell Lung Cancer with Clinical Stage IIIB: Results of a Trimodality Approach

Domenico Galetta, Alfredo Cesario, Stefano Margaritora, Venanzio Porziella, Giuseppe Macis, Rolando M. D'Angelillo, Lucio Trodella, Silvia Sterzi, Pierluigi Granone, Douglas E. Wood, Paul Van Schil, [No Value] Margaritora

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Stage IIIb (T4/N3) non-small-cell lung cancer (NSCLC) is considered an inoperable disease and treatment is an enduring challenge. Surgery after induction therapy seems to improve locoregional control. We report the results of a phase II prospective trimodality trial (chemotherapy and concomitant radiotherapy plus surgery) in patients with stage IIIb NSCLC. Methods. From November 1992 to June 2000, 39 patients (37 men and 2 women, mean age 65 years) with clinical stage IIIb (34 T4N0 to 2, 4 T2 to 3N3, 1 T4N3, excluding T4 for malignant pleural effusion) entered the study. They received intravenous infusions of cisplatin 20 mg/m2 and 5-fluorouracil 1,000 mg/m2 (days 1 to 4 and 25 to 28) combined with a total dose of 50.4 Gy radiotherapy delivered over 4 weeks (1.8 Gy daily). Upon clinical restaging responders underwent surgery. Results. All patients were available for clinical restaging. No complete response was observed. Twenty-one patients had partial response (53.8%), 16 had stable disease (41%), and 2 had progressive disease (5.2%). Hematologic toxicity was moderate. Twenty-two patients (56.4%), 21 with partial response and 1 with stable disease, underwent surgery with no perioperative death. A radical resection was possible in 21 cases. Nine lobectomies, 3 bilobectomies, and 9 pneumonectomies were performed. Complications occurred in 5 patients (23.6%). Fourteen of the patients who underwent surgery (66.6%) showed a pathologic downstaging. A complete pathologic response was obtained in 9 cases (49%). Overall 5-year survival (Kaplan-Meier) was 23%. Resected versus non-resected patients showed a significant difference: 38% versus 5.6% (p = 0.028, log rank). Conclusions. This trimodal approach for stage IIIb NSCLC appears safe and effective. It provides good therapeutic results with acceptable morbidity in surgical cases.

Original languageEnglish
Pages (from-to)1802-1809
Number of pages8
JournalAnnals of Thoracic Surgery
Volume76
Issue number6
DOIs
Publication statusPublished - Dec 2003

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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