title: Impact of preoperative bimodality induction including twice-daily radiation on tumor regression and survival in stage III non-small-cell lung cancer.
abstract: OBJECTIVE
  The objective of this prospective study was to assess the feasibility, toxicity, and efficacy of an intensive trimodality approach in stage III non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  Fifty-four patients with NSCLC and biopsy-proven N2 nodes (IIIA; n = 25) or N3 nodes or T4 lesions (IIIB; n = 29) were administered two initial cycles of ifosfamide, carboplatin, and etoposide; subsequent radiotherapy (45 Gy, twice-daily 1.5 Gy) with concurrent carboplatin and vindesine; and surgery if the patient's disease was resectable or conventional radiotherapy (16 Gy, 2 Gy/d) if the patient's disease was not resectable or incompletely resectable.
  
  
  RESULTS
  Thirty-seven patients (69%) responded to preoperative induction. Forty of 54 patients (74%) had disease that was resectable, with 34 (63%) complete resections (R0). A substantial pathologic response (tumor regression [TR] > 90%) was achieved in 27 of 54 patients (50%) and is revealed as an independent predictor for long-term survival after surgery. Five treatment-related deaths (9%) occurred. With a median follow-up period of 44 months, calculated survival rates at 3 years were 35% for patients with stage IIIA disease, 26% for patients with stage IIIB disease, and 56% for patients with R0 disease and TR > 90%.
  
  
  CONCLUSIONS
  This trimodality approach is feasible and results in encouraging 3-year survival rates in prognostically unfavorable patients with stage III NSCLC. Patients experiencing a 90% degree of pathologic TR were most likely to achieve long-term survival.
authors.affiliation: Department of Hematology/Oncology and Respiratory Medicine, Westfälische-Wilhelms Universität, Muenster, Germany. mthomas@uni-muenster.de
authors.forename: M
authors.initials: M
authors.lastname: Thomas
authors.forename: C
authors.initials: C
authors.lastname: Rübe
authors.forename: M
authors.initials: M
authors.lastname: Semik
authors.forename: M
authors.initials: M
authors.lastname: von Eiff
authors.forename: L
authors.initials: L
authors.lastname: Freitag
authors.forename: H N
authors.initials: HN
authors.lastname: Macha
authors.forename: W
authors.initials: W
authors.lastname: Wagner
authors.forename: F
authors.initials: F
authors.lastname: Klinke
authors.forename: H H
authors.initials: HH
authors.lastname: Scheld
authors.forename: N
authors.initials: N
authors.lastname: Willich
authors.forename: W E
authors.initials: WE
authors.lastname: Berdel
authors.forename: K
authors.initials: K
authors.lastname: Junker
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000473:pathology / Q000628:therapy*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents