title: Postoperative adjuvant chemotherapy and radiotherapy for stage II and III non-small cell lung cancer (NSCLC).
abstract: The role of postoperative adjuvant chemo-radiotherapy in the treatment of patients with non-small cell lung cancer (NSCLC) remains unclear. This study was undertaken to evaluate the survival outcomes, relapse patterns, prognostic factors and complications of postoperative adjuvant MVP chemotherapy and radiotherapy. The study involved some 96 patients who had undergone curative resection of stage II and III NSCLC between 1991 and 1996. Among these, 94 patients who completed their adjuvant treatment were analyzed. Surgery consisted of pneumonectomy (33%), single lobectomy (54%) or bilobectomy (13%). Within 4 weeks of curative resection, two cycles of MVP chemotherapy (mitomycinC 8 mg/m(2), vinblastine 8 mg/m(2), cisplatin 60 mg/m(2)) were started at 4 weeks intervals. Conventionally fractionated radiotherapy was given 3 weeks after chemotherapy to a total dose of 50 Gy in completely resected patients and 55-60 Gy in patients with positive resection margins. The TNM classification of the AJCC, as revised in 1997, was used for pathologic staging. The number of patients at AJCC stages IIa, IIb, IIIa, and IIIb were four, 40, 45, and five, respectively. A pathologically positive bronchial resection margin was found in nine patients. At the time of analysis, death was recorded in 29 patients (31%), though five had died without evidence of lung cancer. Overall 2, 3, and 5-year-survival rates for all patients were 74.2, 70.2, and 65%, respectively, and locoregional disease-free survival (LRDFS) rates were 88.6, 83.7, 74.3%, at 2, 3, and 5-years, distant metastasis disease-free survival (DMDFS) rates were 67.7, 65.0, and 63.6%, respectively. In the multivariate model, a primary tumor size of more than 5 cm and the level of pathologically positive nodes were found to be associated with poor overall survival, LRDFS and DMDFS. Although positive bronchial resection margin affected overall survival, LRDFS and DMDFS were unaffected. With respect to the first site of relapse, distant metastasis occurred more frequently (N=33, 35%) than locoregional recurrence (N=15, 16%). Grade 3 esophagitis in two patients and weight loss of more than 10% in five patients were observed during adjuvant treatment. Grade 4 pulmonary toxicity was observed in one patient after radiotherapy and this patient ultimately died 5 months after treatment. The postoperative adjuvant MVP chemotherapy and radiotherapy regimen showed relatively low locoregional recurrence and distant metastasis rates and good survival with acceptable toxicity. A prospective randomized trial, which compares this regimen to surgery alone or postoperative adjuvant radiotherapy is needed.
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Poongnap-Dong, Songpa-Gyu, Seoul 138-736, South Korea.
authors.forename: Sang-wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Choi
authors.forename: Weon Kuu
authors.initials: WK
authors.lastname: Chung
authors.forename: Kyung Hwan
authors.initials: KH
authors.lastname: Shin
authors.forename: Seung Do
authors.initials: SD
authors.lastname: Ahn
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Sang-We
authors.initials: SW
authors.lastname: Kim
authors.forename: Cheolwon
authors.initials: C
authors.lastname: Suh
authors.forename: Jung Shin
authors.initials: JS
authors.lastname: Lee
authors.forename: Woo Sung
authors.initials: WS
authors.lastname: Kim
authors.forename: Dong Soon
authors.initials: DS
authors.lastname: Kim
authors.forename: Dong Kwan
authors.initials: DK
authors.lastname: Kim
authors.forename: Seung Il
authors.initials: SI
authors.lastname: Park
authors.forename: Kwang-Hyun
authors.initials: KH
authors.lastname: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004941:Esophagitis / Q000209:etiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008937:Mitomycins / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D013534:Survival; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D008937:Mitomycins; D014747:Vinblastine; D002945:Cisplatin