Impact of preoperative bimodality induction including twice-daily radiation on tumor regression and survival in stage III non-small-cell lung cancer

被引:113
作者
Thomas, M
Rübe, C
Semik, M
von Eiff, M
Freitag, L
Macha, HN
Wagner, W
Klinke, F
Scheld, HH
Willich, N
Berdel, WE
Junker, K
机构
[1] Univ Munster, Med Klin A, Dept Hematol Oncol & Resp Med, D-48129 Munster, Germany
[2] Univ Munster, Med Klin A, Dept Thorac & Cardiovasc Surg, D-48129 Munster, Germany
[3] Univ Munster, Med Klin A, Dept Radiat Oncol, D-48129 Munster, Germany
[4] St Elizabeth Hosp, Dept Thorac Surg, Ibbenburen, Germany
[5] Lungenklin Hemer, Hemer, Germany
[6] Univ Hosp Bochum, Bergmannsheil Klin, Inst Pathol, Bochum, Germany
关键词
D O I
10.1200/JCO.1999.17.4.1185
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: The objective of this prospective study was to assess the feasibility, toxicity, and efficacy of an intensive trimodality approach in stage III non-small-cell lung cancer (NSCLC). patients and Methods: Fifty-four patients with NSCLC and biopsy-proven N2 nodes (IIIA; n = 25) or N3 nodes or T4 lesions (IIIB; n = 29) were administered two initial cycles of ifosfamide, carboplatin, and etoposide; subsequent radiotherapy (45 Gy, twice-daily 1.5 Gy) with concurrent carboplatin and vindesine; and surgery if the patient's disease was resectable or conventional radiotherapy (16 Gy, 2 Gy/d) if the patient's disease was not resectable or incompletely resectable. Results: Thirty-seven patients (69%) responded to preoperative induction. Forty of 54 patients (74%) had disease that was resectable, with 34 (63%) complete resections (RO). A substantial pathologic response (tumor regression [TR] > 90%) was achieved in 27 of 54 patients (50%) and is revealed as an independent predictor for long-term survival after surgery. Five treatment-related deaths (9%) occurred. With a median follow-vp period of 44 months, calculated survival rates at 3 years were 35% for patients with stage IIIA disease, 26% for patients with stage IIIB disease, and 56% for patients with RO disease and TR > 90%. Conclusion: This trimodality approach is feasible and results in encouraging 3-year survival rates in prognostically unfavorable patients with stage III NSCLC. Patients experiencing a 90% degree of pathologic TR were most likely to achieve long-term survival. (C) 1999 by American Society of Clinical Oncology.
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页码:1185 / 1193
页数:9
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