title: Trimodality therapy for superior sulcus non-small cell lung cancer: Southwest Oncology Group-Intergroup Trial S0220.
abstract: BACKGROUND
  Although preoperative chemotherapy (cisplatin-etoposide) and radiotherapy, followed by surgical resection, is considered a standard of care for superior sulcus cancers, treatment is rigorous and relapse limits long-term survival. The Southwest Oncology Group-Intergroup Trial S0220 was designed to incorporate an active systemic agent, docetaxel, as consolidation therapy.
  
  
  METHODS
  Patients with histologically proven and radiologically defined T3 to 4, N0 to 1, M0 superior sulcus non-small cell lung cancer underwent induction therapy with cisplatin-etoposide, concurrently with thoracic radiotherapy at 45 Gy. Nonprogressing patients underwent surgical resection within 7 weeks. Consolidation consisted of docetaxel every 3 weeks for 3 doses. The accrual goal was 45 eligible patients. The primary objective was feasibility.
  
  
  RESULTS
  Of 46 patients registered, 44 were eligible and assessable; 38 (86%) completed induction, 29 (66%) underwent surgical resection, and 20 (45% of eligible, 69% surgical, and 91% of those initiating consolidation therapy) completed consolidation docetaxel; 28 of 29 (97%) underwent a complete (R0) resection; 2 (7%) died of adult respiratory distress syndrome. In resected patients, 21 of 29 (72%) had a pathologic complete or nearly complete response. The known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, with 7 in the brain only. The 3-year progression-free survival was 56%, and 3-year overall survival was 61%.
  
  
  CONCLUSIONS
  Although trimodality therapy provides excellent R0 and local control, only 66% of patients underwent surgical resection and only 45% completed the treatment regimen. Even in this subset, distant recurrence continues to be a major problem, particularly brain-only relapse. Future strategies to improve treatment outcomes in this patient population must increase the effectiveness of systemic therapy and reduce the incidence of brain-only metastases.
authors: Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, Simmons Comprehensive Cancer Center, University of Texas Southwestern School of Medicine, Dallas, Texas. Electronic address: kemp.kernstine@utsouthwestern.edu.
authors: Kemp H
authors: KH
authors: Kernstine
authors: Southwest Oncology Group Statistical Center, Seattle, Washington.
authors: James
authors: J
authors: Moon
authors: Providence Cancer Institute, Southfield, Michigan.
authors: Michael J
authors: MJ
authors: Kraut
authors: MD Anderson Cancer Center, Houston, Texas.
authors: Katherine M W
authors: KM
authors: Pisters
authors: Columbia Presbyterian Medical Center, New York, New York.
authors: Joshua R
authors: JR
authors: Sonett
authors: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Valerie W
authors: VW
authors: Rusch
authors: Department of Radiation Medicine, Knight Cancer Institute, Oregon Health Sciences University, Portland, Oregon.
authors: Charles R
authors: CR
authors: Thomas
authors: University Health Network/The Toronto General Hospital, Toronto, Ontario, Canada.
authors: Thomas K
authors: TK
authors: Waddell
authors: Mayo Clinic, Rochester, Minnesota.
authors: James R
authors: JR
authors: Jett
authors: Heartland Cancer Research Community Clinical Oncology Program/Missouri Baptist Medical Center, St. Louis, Missouri.
authors: Alan P
authors: AP
authors: Lyss
authors: Montefiore-Einstein Medical Center, Bronx, New York.
authors: Steven M
authors: SM
authors: Keller
authors: University of California Davis Cancer Center, Sacramento, California.
authors: David R
authors: DR
authors: Gandara
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D000077143:Docetaxel; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D043823:Taxoids / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel