J Korean Med Sci.  2006 Apr;21(2):229-235. 10.3346/jkms.2006.21.2.229.

Preoperative Concurrent Radiochemotherapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer

• Kang MK
• Ahn YC
• Lim DH
• Park K
• Park JO
• Shim YM
• Kim J
• Kim K

• KMID: 1781827
• DOI: http://doi.org/10.3346/jkms.2006.21.2.229

Abstract

This is to examine whether aggressive multimodality therapy improves the treatment outcomes in stage IIIA non-small cell lung cancer (NSCLC). Fifty-three consecutive NSCLC patients with N2 disease, confirmed by mediastinoscopic biopsy, received preoperative thoracic radiation therapy (45 Gy/5 weeks) concurrent with two cycles of oral etoposide and intravenous cisplatin and surgery. Postoperative radiation therapy (PORT, 18 Gy/2 weeks) was optionally recommended for those with the risk factors of loco-regional recurrence based on the surgical and pathological findings. Surgical resection was performed in 38 patients (71.7%), and down-staging was achieved in 19 patients (50%). The median survival period was 27 months in 38 patients who underwent resection, and the rates at 3-yr of overall survival, loco-regional control, distant metastasis-free survival, and disease-free survival were 44.3%, 87.9%, 32.9%, and 29.3%. Significantly favorable factor regarding overall survival was achieving p0/I stage by the multivariate analysis. PORT was successful in reducing locoregional recurrences in patients with the risk factors. Current preoperative concurrent radiochemotherapy and surgery by the authors resulted in comparable survival with other reports, however, further refinement of multimodality approach may be warranted for more effective reduction of distant metastasis.

Keyword

Carcinoma; Non-Small Cell Lung; Preoperative; Radiotherapy; Drug Therapy; Surgery

MeSH Terms

Treatment Failure
Time Factors
Survival Rate
Prognosis
Neoplasm Staging
Middle Aged
Male
Lung Neoplasms/mortality/pathology/*therapy
Humans
Female
Disease-Free Survival
Combined Modality Therapy
Carcinoma, Non-Small-Cell Lung/mortality/pathology/secondary/*therapy
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Aged
Adult

Figure

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  Fig. 1 Treatment scheme. Risk factors, by which the addition of postoperative radiation therapy was considered, included incomplete resection, positive/close resection margins, pN2, and high-risk pN1 diseases.

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  Fig. 2 The patterns of failure in relation to post-surgical risk factors and postoperative radiation therapy (PORT). DM, distant metastasis; LR, local recurrence; NED, no evidence of disease; PS, pleural seeding; RR, regional recurrence. Asterisk denotes failure within the thoracic radiation therapy volume.

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  Fig. 3 Overall survival rates.

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  Fig. 4 Disease-free survival rates of 38 patients who underwent resection. DFS, disease-free survival rate; LRRFS, loco-regional recurrence-free survival rate; DMFS, distant metastasis-free survival rate.

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  Fig. 5 The influence of postoperative stage on distant metastasis-free survival.

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