title: Phase II trial of sequential chemotherapy followed by chemoradiation, surgery, and postoperative chemotherapy for the treatment of stage IIIA/IIIB non-small-cell lung cancer.
abstract: BACKGROUND
  The optimal treatment of locally advanced non-small-cell lung cancer remains a challenge. Although the benefit of combined chemoradiation has been established, the optimal chemotherapy regimen, timing of full-dose chemotherapy, and how best to combine chemotherapy with radiation to maximize systemic and radiosensitizing effects remain unclear.
  
  
  METHODS
  Twenty-nine patients with pathologically confirmed stage IIIA/IIIB non-small-cell lung cancer were included in a phase II trial of sequential carboplatin/paclitaxel followed by chemoradiation, surgery, and postoperative gemcitabine. Twenty-five patients (86%) completed the concurrent chemotherapy and radiation therapy phase and were eligible for surgery. At restaging, 7 patients (21%) showed disease progression. Seventeen patients (59%) went on to surgery. Few were able to tolerate full postoperative chemotherapy.
  
  
  RESULTS
  The 1-year overall survival rate was 61%, with a 2-year survival rate of 56%. Median overall survival was 25.2 months. Seven of the patients are alive and without recurrence at the time of this writing. Our median follow-up time was 22.2 months. Reversible grade 3/4 toxicities were fairly common, experienced in 45% of patients.
  
  
  CONCLUSIONS
  Our results with this combined modality approach are comparable with those of previous, similar studies. Postoperative chemotherapy after initial combined modality therapy is often not feasible, reinforcing the value of initial systemic therapy. Long-term results are still suboptimal and await studies adding targeted therapies to our usual chemotherapy/radiation approaches.
authors.affiliation: Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. plam1@bidmc.harvard.edu
authors.forename: Prudence
authors.initials: P
authors.lastname: Lam
authors.forename: Stuart
authors.initials: S
authors.lastname: Berman
authors.forename: Robert
authors.initials: R
authors.lastname: Thurer
authors.forename: Simon
authors.initials: S
authors.lastname: Ashiku
authors.forename: Malcolm
authors.initials: M
authors.lastname: DeCamp
authors.forename: Michael
authors.initials: M
authors.lastname: Goldstein
authors.forename: Susan
authors.initials: S
authors.lastname: Schumer
authors.forename: Balazs
authors.initials: B
authors.lastname: Halmos
authors.forename: Daniel
authors.initials: D
authors.lastname: Karp
authors.forename: Danielle
authors.initials: D
authors.lastname: Coute
authors.forename: Mark
authors.initials: M
authors.lastname: Bergman
authors.forename: Cynthia
authors.initials: C
authors.lastname: Boyd-Sirard
authors.forename: Sai-Hong
authors.initials: SH
authors.lastname: Ou
authors.forename: Alona
authors.initials: A
authors.lastname: Muzikansky
authors.forename: Cally
authors.initials: C
authors.lastname: Woodard
authors.forename: Mark
authors.initials: M
authors.lastname: Huberman
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016190:Carboplatin / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000009:adverse effects / Q000627:therapeutic use*; D011182:Postoperative Care; D013908:Thoracotomy
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D017239:Paclitaxel