title: Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas: long-term results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160).
abstract: OBJECTIVE
  Traditional treatment for superior sulcus non-small-cell lung cancers (SS NSCLC), radiation plus surgery, yields a 50% rate of complete resection and a 30% 5-year survival. On the basis of improved outcomes in other subsets of stage III NSCLC, this trial tested the feasibility of induction chemoradiotherapy for SS NSCLC.
  
  
  METHODS
  Patients with T3-4, N0-1 SS NSCLC received two cycles of cisplatin and etoposide concurrently with radiation (45 Gy). Patients with stable or responding disease underwent thoracotomy. All patients received two more cycles of chemotherapy. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed by Cox regression analysis.
  
  
  RESULTS
  From April 1995 to November 1999, 110 eligible patients (76 men, 34 women) were entered onto the study (78 T3, 32 T4 tumors). Induction therapy was completed by 104 (95%) patients. Of 95 patients eligible for surgery, 88 (80%) underwent thoracotomy, two (1.8%) died postoperatively, and 83 (76%) had complete resection. Pathologic complete response (CR) or minimal microscopic disease was seen in 61 (56%) resection specimens. Five-year survival was 44% for all patients and 54% after complete resection, with no difference between T3 and T4 tumors. Pathologic CR led to better survival than when any residual disease was present (P = .02). Disease progression occurred mainly in distant sites.
  
  
  CONCLUSIONS
  This combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.
authors.affiliation: Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: Giroux
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kraut
authors.forename: John
authors.initials: J
authors.lastname: Crowley
authors.forename: Mark
authors.initials: M
authors.lastname: Hazuka
authors.forename: Timothy
authors.initials: T
authors.lastname: Winton
authors.forename: David H
authors.initials: DH
authors.lastname: Johnson
authors.forename: Lawrence
authors.initials: L
authors.lastname: Shulman
authors.forename: Frances
authors.initials: F
authors.lastname: Shepherd
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.forename: Robert B
authors.initials: RB
authors.lastname: Livingston
authors.forename: David
authors.initials: D
authors.lastname: Gandara
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012074:Remission Induction
chemical_list: D005047:Etoposide; D002945:Cisplatin