title: Lessons to learn from EORTC study 08981: a feasibility study of induction chemoradiotherapy followed by surgical resection for stage IIIB non-small cell lung cancer.
abstract: The present EORTC phase II feasibility study in stage IIIB (T4-N3) NSCLC was conducted to investigate whether an induction regimen with concurrent chemoradiotherapy followed by surgery after restaging by re-mediastinoscopy and/or fluorodeoxyglucose-positron emission tomography (FDG-PET) was feasible in a multicenter setting. Unfortunately, the study closed prematurely because of poor accrual. The combination of more stringent selection criteria, the incorrect prevailing view of Ethical Boards that a tri-modality approach is too toxic, competing studies in the participating centers and the fact that patients with N3 disease could only be enrolled if a re-mediastinoscopy could be performed, underlie the low accrual. Although this study illustrates that the conduct of a tri-modality study across Europe appeared to be difficult at that time, the number of centers with highly qualified and experienced specialists involved in this kind of multi-modality approaches is rapidly increasing. Future initiatives should, therefore, certainly be encouraged. Minimally invasive procedures such as EUS and EBUS should preferably be used for up-front mediastinal staging, mediastinoscopy with or without EUS should preferably be reserved for restaging, and especially right-sided pneumonectomies should be avoided. Though evident, the feasibility to complete this kind of studies within a reasonable time period is still a condition sine qua non.
authors.affiliation: Department of Pulmonology, Erasmus MC-Daniel Den Hoed Cancer Center, Groene Hilledijk 301, 3008 AE Rotterdam, The Netherlands. v.surmont@erasmusmc.nl
authors.forename: V
authors.initials: V
authors.lastname: Surmont
authors.forename: R J
authors.initials: RJ
authors.lastname: van Klaveren
authors.forename: C
authors.initials: C
authors.lastname: Goor
authors.forename: F
authors.initials: F
authors.lastname: Schramel
authors.forename: C
authors.initials: C
authors.lastname: Manegold
authors.forename: C
authors.initials: C
authors.lastname: Legrand
authors.forename: P
authors.initials: P
authors.lastname: Van Schil
authors.forename: J P
authors.initials: JP
authors.lastname: Van Meerbeeck
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18