Induction chemotherapy, concurrent chemoradiation and surgery for Pancoast tumour.
The traditional treatment of Pancoast tumour with local approaches (surgery, radiotherapy or a combination of both) leads to a poor outcome due to the high rate of incomplete resection and the lack of systemic control. The aim of the present prospective feasibility study was to determine whether a trimodality approach improves local control and survival. Patients with stage IIB-IIIB Pancoast tumour received induction chemotherapy (three courses of split-dose cisplatin and etoposide or paclitaxel) followed by concurrent chemoradiotherapy (a course of cisplatin/etoposide combined with 45 Gy hyperfractionated accelerated radiotherapy). After restaging, eligible patients underwent surgery 4-6 weeks post-radiation. A total of 31 consecutive patients with T3 (81%) or T4 (19%) Pancoast tumour were enrolled in the study. Induction chemoradiotherapy was completed in all patients without treatment-related deaths. Grade 3-4 toxicity was observed in 32% of cases. In total, 29 (94%) patients were eligible for surgery. Complete resection was achieved in 94% of patients. The post-operative mortality rate was 6.4% and major complications arose in 20.6% of the patients. The median survival was 54 months with 2- and 5-yr survival rates of 74 and 46%, respectively. In conclusion, this intensive multimodality treatment of Pancoast tumour is feasible and improves local resectability rates and long-term survival as compared with historical series.
Marra
A
A
Dept of Thoracic Surgery and Endoscopy, Ruhrlandklinik, Tueschener Weg 40, 45239 Essen, Germany. alexmarra@yahoo.it.
Eberhardt
W
W
Pöttgen
C
C
Theegarten
D
D
Korfee
S
S
Gauler
T
T
Stuschke
M
M
Stamatis
G
G
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage*; D005047:Etoposide / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010178:Pancoast Syndrome / Q000401:mortality / Q000628:therapy*; D011013:Pneumonectomy; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate
D000970:Antineoplastic Agents; D005047:Etoposide; D002945:Cisplatin