title: Chemotherapy and high dose radiotherapy followed by resection for locally advanced nonsmall cell lung cancers.
abstract: 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.
authors.affiliation: Department of Radiation & Cellular Oncology, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Arif Y
authors.initials: AY
authors.lastname: Shaikh
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Haraf
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
authors.forename: Ravi
authors.initials: R
authors.lastname: Salgia
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hoffman
authors.forename: Mark K
authors.initials: MK
authors.lastname: Ferguson
authors.forename: Philip P
authors.initials: PP
authors.lastname: Connell
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D017671:Platinum Compounds