A phase II trial of chemotherapy and surgery for non-small cell lung cancer patients with a synchronous solitary metastasis.
OBJECTIVE
Retrospective reports suggest that selected patients with non-small cell lung cancer (NSCLC) and a solitary synchronous site of M(1) disease may be effectively treated by resection of all disease sites. The feasibility and potential benefit of combining surgery and chemotherapy in this setting are unclear. Therefore, we performed a prospective trial to test this therapeutic approach.


METHODS
Patients with solitary synchronous M(1) NSCLC with or without N(2) disease were to receive three cycles of mitomycin, vinblastine, cisplatin (MVP) chemotherapy, followed by resection of all disease sites, and then two cycles of VP chemotherapy. Solitary brain metastases were to be resected before chemotherapy.


RESULTS
From 10/92-2/99, 23 patients (12 men, 11 women, median age = 55 years) were enrolled. Mediastinoscopy, performed in 22 patients, showed involved N(2) nodes in 12. The M(1) sites included brain (14 patients) adrenal (3), bone (3), spleen (1), lung (1), and colon (1). Of 12 patients who completed all three induction therapy cycles, 8 underwent R(0) resections. Another 5 patients had R(0) resections without completing induction therapy. Eight of the 13 patients undergoing R(0) resections completed postoperative chemotherapy. The median survival was 11 months; 2 patients survived to 5 years without disease.


CONCLUSIONS
(1) The number of patients with solitary M(1) disease who qualified for this combined modality therapy was small; (2) MVP was poorly tolerated as induction chemotherapy in this patient population; (3) Compared to historical experience with surgery alone, overall survival does not appear to be superior with this treatment strategy.
Downey
Robert J
RJ
Thoracic Services, Memorial Sloan-Kettering Cancer Center, Division of Thoracic Surgery, 1275 York Avenue, New York, NY 10021, USA. downeyr@mskcc.org
Ng
Kenneth K
KK
Kris
Mark G
MG
Bains
Manjit S
MS
Miller
Vincent A
VA
Heelan
Robert
R
Bilsky
Mark
M
Ginsberg
Robert
R
Rusch
Valerie W
VW
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008937:Mitomycins / Q000008:administration & dosage; D009362:Neoplasm Metastasis; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
D008937:Mitomycins; D014747:Vinblastine; D002945:Cisplatin