Chemotherapy and high dose radiotherapy followed by resection for locally advanced nonsmall cell lung cancers.
OBJECTIVE
For locally advanced but technically operable nonsmall cell lung cancer (NSCLC), neoadjuvant chemoradiotherapy is frequently used. Ideal radiotherapy dose in this context is unclear.


METHODS
Twenty-six NSCLC patients with N2 disease were retrospectively reviewed. All received preoperative concurrent platinum-based chemoradiotherapy. Gross tumor volumes received a median of 58 Gy (range, 50-60 Gy).


RESULTS
Two patients experienced major complications and died, resulting in a postoperative mortality rate of 7.7%. Three patients (11.5%) had minor complications. Pathologic specimens revealed downstaging in 76.9% of patients. The pathologic complete response (CR) rate was 34.6%. Downstaging of nodes was observed in 20 of 26 patients. With a median follow-up of 18.3 months, the 1- and 3-year actuarial survival rates were 80.2% and 45.7%, respectively. The 1- and 3-year actuarial disease-free survival (DFS) rates were 76.9% and 37.3%, respectively. Patients experiencing mediastinal downstaging had better DFS rates, relative to patients that did not (18-month DFS = 79.2% vs. 0%; P = 0.0001). Differences in RT dose (50-60 Gy) and types of chemotherapeutic regimens did not significantly impact pathologic downstaging rates, CR rates, DFS, or survival.


CONCLUSIONS
Neoadjuvant chemotherapy with high-dose concurrent RT is well tolerated and results in favorable outcomes.
Shaikh
Arif Y
AY
Department of Radiation & Cellular Oncology, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA.
Haraf
Daniel J
DJ
Salama
Joseph K
JK
Salgia
Ravi
R
Hoffman
Philip C
PC
Ferguson
Mark K
MK
Connell
Philip P
PP
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017671:Platinum Compounds / Q000627:therapeutic use; D011013:Pneumonectomy; D011878:Radiotherapy; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D017671:Platinum Compounds