Present status of induction treatment in stage IIIA-N2 non-small cell lung cancer: a review

• Published in: European journal of cardio-thoracic surgery Vol. 13; no. 1; pp. 1 - 12
• Main Authors: Vansteenkiste, Johan, De Leyn, Paul, Deneffe, Georges, Menten, Johan, Lerut, Tony, Demedts, Maurits
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01-01-1998; Elsevier Science
• Subjects: Antineoplastic agents; Biological and medical sciences; Combined modality treatment; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Induction chemotherapy; Lung surgery; Medical sciences; N2 disease; Non-small cell lung carcinoma; Pharmacology. Drug treatments; Non-small cell lung carcinoma; Combined modality treatment; Induction chemotherapy; N2 disease; Lung surgery; Human; Lung disease; Prognosis; Respiratory disease; Treatment efficiency; Malignant tumor; Radiotherapy; Survival; Induction treatment; Bronchopulmonary; Chemotherapy; Bronchus disease; Preoperative; Bibliographic review
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(97)00267-4

Background: Surgical exploration in mediastinoscopy proven N2 non-small cell lung cancer (NSCLC) is unrewarding. Theoretical concepts suggest a beneficial role for preoperative induction treatment. The solidity of the therapeutic results with this approach in the currently available data is examined. Methods: Literature on induction therapy followed by surgical exploration, consisting of randomized reports and phase II reports meeting some essential criteria, are reviewed. Results: Of the twenty-four analyzed phase II studies, thirteen lack adequate surgical staging. Stratification for various important prognostic factors in N2 disease is missing in many instances. Results with induction with a cisplatinum dose of less than 80 mg/m2 seem to be inferior. The use of mitomycin-C in patients scheduled for lung resection or irradiation deserves caution. No evident difference in efficacy between induction chemotherapy or chemo-radiotherapy is suggested, but toxicity and mortality appear to be somewhat higher with chemo-radiotherapy. Pathological complete response is mainly found after an at least partial clinical response. Effect on survival in non-controlled phase II studies and small randomized reports is encouraging. Conclusions: the role of chemotherapy induction in improving the long-term survival of N2 NSCLC is promising, but needs to be confirmed by large multi-center randomized data. Adequate surgical staging and attention to important prognostic factors in N2 disease should minimize the numerous institution based differences interfering in the currently available non-controlled studies.