title: Radiological response and survival in locally advanced non-small-cell lung cancer patients treated with three-drug induction chemotherapy followed by radical local treatment.
abstract: OBJECTIVE
  If concurrent chemoradiotherapy cannot be performed, induction chemotherapy followed by radical-intent surgical treatment is an acceptable option for non primarily resectable non-small-cell lung cancers (NSCLCs). No markers are available to predict which patients may benefit from local treatment after induction. This exploratory study aims to assess the feasibility and the activity of multimodality treatment, including triple-agent chemotherapy followed by radical surgery and/or radiotherapy in locally advanced NSCLCs.
  
  
  METHODS
  We retrospectively collected data from locally advanced NSCLCs treated with induction chemotherapy with carboplatin (area under the curve 6, d [day]1), paclitaxel (200 mg/m(2), d1), and gemcitabine (1,000 mg/m(2) d1, 8) for three to four courses, followed by radical surgery and/or radiotherapy. We analyzed radiological response and toxicity. Estimated progression-free survival (PFS) and overall survival (OS) were correlated to response, surgery, and clinical features.
  
  
  RESULTS
  In all, 58 NSCLCs were included in the study: 40 staged as IIIA, 18 as IIIB (according to TNM Classification of Malignant Tumors-7th edition staging system). A total of 36 (62%) patients achieved partial response (PR), and six (10%) progressions were recorded. Grade 3-4 hematological toxicity was observed in 36 (62%) cases. After chemotherapy, 37 (64%) patients underwent surgery followed by adjuvant radiotherapy, and two patients received radical-intent radiotherapy. The median PFS and OS were 11 months and 23 months, respectively. Both PFS and OS were significantly correlated to objective response (P<0.0001) and surgery (P<0.0001 and P=0.002). Patients obtaining PR and receiving local treatment achieved a median PFS and OS of 35 and 48 months, respectively. Median PFS and OS of patients not achieving PR or not receiving local treatment were 5-7 and 11-15 months, respectively. The extension of surgery did not affect the outcome.
  
  
  CONCLUSIONS
  The multimodality treatment was feasible, and triple-agent induction was associated with a considerable rate of PR. Patients achieving PR and receiving radical surgery or radiotherapy (53%) achieved a median OS of 4 years.
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS.
authors.forename: Laura
authors.initials: L
authors.lastname: Bonanno
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS.
authors.forename: Giulia
authors.initials: G
authors.lastname: Zago
authors.affiliation: Thoracic Surgery Department, University of Padova.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.affiliation: Clinical Trials and Biostatistics Unit, Veneto Institute of Oncology IOV-IRCCS.
authors.forename: Paola
authors.initials: P
authors.lastname: Del Bianco
authors.affiliation: Thoracic Surgery Department, University of Padova.
authors.forename: Marco
authors.initials: M
authors.lastname: Schiavon
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pasello
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS; Department of Surgery, Oncology and Gastroenterology, University of Padova.
authors.forename: Valentina
authors.initials: V
authors.lastname: Polo
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS.
authors.forename: Fabio
authors.initials: F
authors.lastname: Canova
authors.affiliation: Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tonetto
authors.affiliation: Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Loreggian
authors.affiliation: Thoracic Surgery Department, University of Padova.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS; Department of Surgery, Oncology and Gastroenterology, University of Padova.
authors.forename: PierFranco
authors.initials: P
authors.lastname: Conte
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Favaretto
keywords: neoadjuvant chemotherapy; pneumonectomy; radiotherapy; stage III lung cancer; surgery