Induction chemoradiotherapy (carboplatin-taxane and concurrent 50-Gy radiation) for bulky cN2, N3 non–small cell lung cancer

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 133; no. 5; pp. 1179 - 1185
• Main Authors: Yokomise, Hiroyasu, MD, Gotoh, Masashi, MD, Okamoto, Taku, MD, Yamamoto, Yasumichi, MD, Ishikawa, Shinya, MD, Nakashima, Takashi, MD, Masuya, Daiki, MD, Liu, Dage, MD, Huang, Cheng-long, MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-05-2007; AATS/WTSA; Elsevier
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bridged-Ring Compounds - administration & dosage; Carboplatin - administration & dosage; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Carcinoma, Non-Small-Cell Lung - therapy; Cardiothoracic Surgery; Female; Humans; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lung Neoplasms - therapy; Male; Medical sciences; Middle Aged; Neoadjuvant Therapy; Pneumology; Radiotherapy Dosage; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Taxoids - administration & dosage; Tumors of the respiratory system and mediastinum; computed tomography; FDG-PET; CD; cisplatin-etoposide; NSCLC; carboplatin-paclitaxel; non–small cell lung cancer; EP; CP; standardized uptake value; CT; carboplatin-docetaxel; SUV; positron emission tomography with fludeoxyglucose F 18; 10; Antineoplastic agent; Heart; Lung disease; Respiratory disease; Induction; Concurrent; Radiation; Thorax; Malignant tumor; non-small cell lung carcinoma; Chemoradiotherapy; Concomitant disease; Treatment; Surgery; Carboplatin; Bronchus disease; Platinum II Complexes; Non small cell carcinoma
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2006.12.039

Objective To improve the prognosis of cN2, N3 non–small cell lung cancer, we performed induction chemoradiotherapy (carboplatin-taxane chemotherapy and concurrent 50-Gy radiation) followed by surgery. Methods Patients with pathologically proven non–small cell lung cancer with bulky cN2, N3 disease were enrolled. Forty-one patients underwent an operation after chemoradiotherapy from January 2000 to April 2006. Either carboplatin-paclitaxel (n = 19) or carboplatin-docetaxel (n = 22) chemotherapy was randomly used. Two cycles of chemotherapy were performed with concurrent radiation (50 Gy). In all cases, conventional radiological reevaluations were performed; in the latest 21 cases, reevaluations with positron-emission tomography with fludeoxyglucose F 18 were also performed. Results In all 41 cases, complete resections were performed, with no operative mortality. The histologically complete response rate, major response rate, and minor response rate were 17.1% (7/41), 56.1% (23/41), and 26.8% (11/41), respectively. The 5-year overall survival was 52.7%. There were no differences in survival between taxane groups. Both the complete response and the major response groups revealed a significantly better 5-year survivals than the minor response group (85.7%, P = .044, 52.4%, P = .01). Even with persistent N2 disease, the 5-year survival in the major response group (66%) was promising. With the combination of conventional computed tomography and positron-emission tomography with fludeoxyglucose F 18 for reevaluation, eligible patients could be selected for this protocol. Conclusion Surgery after chemoradiotherapy (carboplatin-taxane and 50-Gy radiation) for bulky cN2, N3 non–small cell lung cancer can be safely performed with promising results. Even with persistent N2 disease, the survival in the major response group was promising.