10-year long-term survival (LTS) of induction chemotherapy with three cycles cisplatin/paclitaxel followed by concurrent chemoradiation cisplatin/etoposide/45 Gy (1.5 Gy bid) plus surgery in locally advanced non-small-cell lung cancer (NSCLC)¡ª

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• 作者：Wilfried Ernst Erich Eberhardt ; Thomas Christoph Gauler ; Cecile LePechoux ; Georgios Stamatis ; Stephan Bildat ; Thomas Krbek ; Stefan Welter ; Dominique Grunenwald ; Berthold Fischer ; Hepp de los Rios Rodrigo ; Dirk Theegarten ; Thierry Le Chevalier ; Siegfried Seeber ; Martin Stuschke ; Christoph Poettgen
• 关键词：Lung cancer ; Trimodality treatment ; Induction chemoradiotherapy ; Surgery ; 10-Year survival ; Prognostic factors
• 刊名：Lung Cancer
• 出版年：2013
• 出版时间：October, 2013
• 年：2013
• 卷：82
• 期：1
• 页码：83-89
• 全文大小：823 K

文摘

Background

Induction chemoradiotherapy plus surgery remains an option to study in IIIA(N2) and selected IIIB NSCLC. Here we report ten-year long-term survival of a prospective multicenter German-French phase-II trial with trimodality.

Patients and methods

Mediastinoscopically proven IIIA(N2)/selected IIIB NSCLC received three cycles cisplatin (50 mg/m² day 1 + 8) and paclitaxel (175 mg/m² d1) qd 22. Concurrent CTx/RTx followed: 45 Gy (1.5 Gy bid) with cisplatin 50 mg/m² day 2 + 9 and etoposide 100 mg/m² d 4-6. Surgery was planned three to five weeks after RTx. If evaluated inoperable/irresectable at the end of RTx, definitive RTx-boost (20 Gy; 2 Gy qd) followed. Here we report 10-year-LTS for this cohort.

Results

All 64 patients were accrued 3/99 to 2/02. Patients characteristics: IIIA(N2)/IIIB 25/39; m/f 48/16; adeno/squamous/large-cell/adenosquamous/NOS 15/26/18/3/2; age: median 52.5 (range 33-69). 36 operated: R0 32/36 (89 % ); pCR 16/36 (44 % ). 10-year-LTS % ; all 26.0; IIIA(N2) 37.1; IIIB 17.9; relevant prognostic factors (exploratory): pretreatment - histopathology (squamous/adeno) - age (<50/¡Ý50) - Charlson-CI: 1/>1 - BMI (¡Ý25/<25) - pack years smoking (¡Ý10/<10); treatment-dependent - R0/no-R0.

Conclusions

This regimen achieves substantial LTS. Interestingly, adenocarcinomas, older patients, unfavorable comorbidity scores, higher BMI and light smokers demonstrate poor long-term outcome even with aggressive trimodality. This dataset defines the rationale for our ongoing randomized trial with surgery after induction therapy in IIIA(N2)/selected IIIB (ESPAT¨¹).