J Korean Soc Ther Radiol Oncol.  1999 Jun;17(2):100-107.

Pre-operative Concurrent Chemoradiotherapy for Stage IIIA (N2) Non-Small Cell Lung Cancer

• Lee KC
• Ahn YC
• Park K
• Kim KM
• Kim JG
• Shim YM
• Lim DH
• Kim MK
• Shin KH
• Kim DY
• Huh SJ
• Rhee CH
• Lee KS
• Han J

Abstract

PURPOSE
This is to evaluate the acute complication, resection rate, and tumor down-staging after pre-operative concurrent chemoradiotherapy for stage IIIA (N2) non-small cell lung cancer.
MATERIALS AND METHODS
Fifteen patients with non-small cell lung cancer were enrolled in this study from May 1997 to June 1998 in Samsung Medical Center. The median age of the patients was 61 (range, 45~67) years and male to female ratio was 12:3. Pathologic types were squamous cell carcinoma (11) and adenocarcinoma (4). Pre-operative clinical tumor stages were cT1 in 2 patients, cT2 in 12, and cT3 in 1 and all were N2. Ten patients were proved to be N2 with mediastinoscopic biopsy and five had clinically evident mediastinal lymph node metastases on the chest CT scans. Pre-operative radiation therapy field included the primary tumor, the ipsilateral hilum, and the mediastinum. Total radiation dose was 45 Gy over 5 weeks with daily dose of 1.8 Gy. Pre-operative concurrent chemotherapy consisted of two cycles of intravenous cis-Platin (100 mg/m2) on day 1 and oral Etoposide (50 mg/m2/day) on days 1 through 14 with 4 weeks' interval. Surgery was followed after the pre-operative re-evaluation including chest CT scan in 3 weeks of the completion of the concurrent chemoradiotherapy if there was no evidence of disease progression.
RESULTS
Full dose radiation therapy was administered to all the 15 patients. Planned two cycles of chemotherapy was completed in 11 patients and one cycle was given to four. One treatment related death of acute respiratory distress syndrome occurred in 15 days of surgery. Hospital admission was required in three patients including one with radiation pneumonitis and two with neutropenic fever. Hematologic complications and other acute complications including esophagitis were tolerable. Resection rate was 92.3% (12/13) in 13 patients excluding two patients who refused surgery. Pleural seeding was found in one patient after thoracotomy and tumor resection was not feasible. Post-operative tumor stagings were pT0 in 3 patients, pT1 in 6, and pT2 in 3. Lymph node status findings were pN0 in 8 patients, pN1 in 1, and pN2 in 3. Pathologic tumor down-staging was 61.5% (8/13) including complete response in three patients (23.7%). Tumor stage was unchanged in four patients (30.8%) and progression was in one (7.7%).
CONCLUSION
Pre-operative concurrent chemoradiotherapy for Stage IIIA (N2) non-small cell lung cancer demonstrated satisfactory results with no increased severe acute complications. This treatment scheme deserves more patient accrual with long-term follow-up.

Keyword

Non-small cell lung cancer; Pre-operative Concurrent chemoradiotherapy

MeSH Terms

Adenocarcinoma
Biopsy
Carcinoma, Non-Small-Cell Lung*
Carcinoma, Squamous Cell
Chemoradiotherapy*
Disease Progression
Drug Therapy
Esophagitis
Etoposide
Female
Fever
Follow-Up Studies
Humans
Lymph Nodes
Male
Mediastinum
Neoplasm Metastasis
Radiation Pneumonitis
Respiratory Distress Syndrome, Adult
Thoracotomy
Tomography, X-Ray Computed
Etoposide