Chemoradiation therapy followed by surgery

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67]

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67]

In the first trial (NCT00002642), 110 eligible patients were enrolled with mediastinoscopy negative, clinical T3–4, N0–1 tumors of the superior sulcus.[67] Induction treatment was two cycles of etoposide and cisplatin with 45 Gy of concurrent radiation therapy.

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67] › In the first trial (NCT00002642), 110 eligible patients were enrolled with mediastinoscopy negative, clinical T3–4, N0–1 tumors of the superior sulcus.[67] Induction treatment was two cycles of etoposide and cisplatin with 45 Gy of concurrent radiation therapy.

The induction regimen was well tolerated, and only five participants had grade 3 or higher toxic effects.

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67] › In the first trial (NCT00002642), 110 eligible patients were enrolled with mediastinoscopy negative, clinical T3–4, N0–1 tumors of the superior sulcus.[67] Induction treatment was two cycles of etoposide and cisplatin with 45 Gy of concurrent radiation therapy.

Induction chemoradiation therapy could sterilize the primary lesion. Induction therapy was completed by 104 patients (95%). Of the 95 patients eligible for surgery, 88 (80%) underwent thoracotomy, two (1.8%) died postoperatively, and 83 (76%) had complete resections.

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67] › In the first trial (NCT00002642), 110 eligible patients were enrolled with mediastinoscopy negative, clinical T3–4, N0–1 tumors of the superior sulcus.[67] Induction treatment was two cycles of etoposide and cisplatin with 45 Gy of concurrent radiation therapy.

Pathological complete response or minimal microscopic disease was seen in 61 (56%) resection specimens. Pathological complete response led to better survival than when any residual disease was present (P = .02).

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67] › In the first trial (NCT00002642), 110 eligible patients were enrolled with mediastinoscopy negative, clinical T3–4, N0–1 tumors of the superior sulcus.[67] Induction treatment was two cycles of etoposide and cisplatin with 45 Gy of concurrent radiation therapy.

Five-year survival was 44% for all patients and 54% after complete resection, with no difference between T3 and T4 tumors. Disease progression occurred mainly in distant sites.

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67]

In the second trial, 75 patients were enrolled and treated with induction therapy with mitomycin C, vindesine, and cisplatin combined with 45 Gy of radiation therapy.[66] Fifty-seven patients (76%) underwent surgical resection, and complete resection was achieved in 51 patients (68%).

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67] › In the second trial, 75 patients were enrolled and treated with induction therapy with mitomycin C, vindesine, and cisplatin combined with 45 Gy of radiation therapy.[66] Fifty-seven patients (76%) underwent surgical resection, and complete resection was achieved in 51 patients (68%).

There were 12 patients with pathological complete response.

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67] › In the second trial, 75 patients were enrolled and treated with induction therapy with mitomycin C, vindesine, and cisplatin combined with 45 Gy of radiation therapy.[66] Fifty-seven patients (76%) underwent surgical resection, and complete resection was achieved in 51 patients (68%).

Major postoperative morbidity, including chylothorax, empyema, pneumonitis, adult respiratory distress syndrome, and bleeding, was observed in eight patients. There were three treatment-related deaths.

Two large, prospective, multicenter phase II trials have evaluated induction chemoradiation therapy followed by resection.[66,67] › In the second trial, 75 patients were enrolled and treated with induction therapy with mitomycin C, vindesine, and cisplatin combined with 45 Gy of radiation therapy.[66] Fifty-seven patients (76%) underwent surgical resection, and complete resection was achieved in 51 patients (68%).

At 3 years, the DFS rate was 49%, and the OS rate was 61%; at 5 years, the DFS rate was 45%, and the OS rate was 56%.[66][Level of evidence C2]