Long-Term Results of Combined-Modality Therapy in Resectable Non–Small-Cell Lung Cancer

2002 ◽  
Vol 20 (8) ◽  
pp. 1989-1995 ◽  
Author(s):  
Jocelyne Martin ◽  
Robert J. Ginsberg ◽  
Ennapadam S. Venkatraman ◽  
Manjit S. Bains ◽  
Robert J. Downey ◽  
...  
Keyword(s):  
Combined Modality Therapy ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Complete Resection ◽  
Small Cell ◽  
Long Term Results ◽  
Small Cell Lung ◽  
Combined Modality

PURPOSE: Assessment of long-term results of combined-modality therapy for resectable non–small-cell lung cancer is hampered by insufficient follow-up and small patient numbers. To evaluate this, we reviewed our collective experience. PATIENTS AND METHODS: This study was a retrospective chart review recording demographics, tumor stage, treatment, and outcome of consecutive patients undergoing surgery. Survival was analyzed by Kaplan-Meier, and prognostic factors were analyzed by log-rank and Cox regression. RESULTS: From January 1993 to December 1999, 470 patients were treated, with follow-up in 446: 27 stage I, 55 stage II, 316 stage III, 43 stage IV (solitary M1), and five uncertain. Chemotherapy was mitomycin/vinblastine/cisplatin (174 patients [39.0%]), carboplatin/paclitaxel (148 [33.2%]), and other combination (124 [27.8%]); 75 patients (16.8%) received induction radiation. Resection was complete in 77.4%, incomplete in 8.3%, attempted but with gross residual disease afterward in 1.8%, and not performed in 12.6%. Pathologic complete response occurred in 20 patients (4.5%). With median follow-up of 31.0 months for patients still alive, median and 3-year survival for pathologic stages 0, I, II, III, and IV were more than 90 months, 73%; 42 months, 52%; 23 months, 35%; 16 months, 28%; and 16 months, 23% (P < .001). In a multivariate analysis, age, complete resection, pathologic stage, and pneumonectomy, but not induction regimen, significantly influenced survival. CONCLUSION: Although pathologic complete response outside the protocol setting is low, survival of this large patient cohort is comparable to that of patients in published combined-modality trials. Survival is significantly influenced by patient age, complete resection, pathologic stage, and pneumonectomy. These results can help guide standard clinical practice and emphasize the need for novel induction regimens.

Induction Chemoradiation and Surgical Resection for Superior Sulcus Non–Small-Cell Lung Carcinomas: Long-Term Results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160)

2007 ◽  
Vol 25 (3) ◽  
pp. 313-318 ◽  
Author(s):  
Valerie W. Rusch ◽  
Dorothy J. Giroux ◽  
Michael J. Kraut ◽  
John Crowley ◽  
Mark Hazuka ◽  
...  
Keyword(s):  
Cox Regression ◽  
Residual Disease ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Complete Resection ◽  
Small Cell ◽  
Long Term Results ◽  
Small Cell Lung ◽  
Cox Regression Analysis ◽  
Superior Sulcus

PurposeTraditional treatment for superior sulcus non–small-cell lung cancers (SS NSCLC), radiation plus surgery, yields a 50% rate of complete resection and a 30% 5-year survival. On the basis of improved outcomes in other subsets of stage III NSCLC, this trial tested the feasibility of induction chemoradiotherapy for SS NSCLC.Patients and MethodsPatients with T3-4, N0-1 SS NSCLC received two cycles of cisplatin and etoposide concurrently with radiation (45 Gy). Patients with stable or responding disease underwent thoracotomy. All patients received two more cycles of chemotherapy. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed by Cox regression analysis.ResultsFrom April 1995 to November 1999, 110 eligible patients (76 men, 34 women) were entered onto the study (78 T3, 32 T4 tumors). Induction therapy was completed by 104 (95%) patients. Of 95 patients eligible for surgery, 88 (80%) underwent thoracotomy, two (1.8%) died postoperatively, and 83 (76%) had complete resection. Pathologic complete response (CR) or minimal microscopic disease was seen in 61 (56%) resection specimens. Five-year survival was 44% for all patients and 54% after complete resection, with no difference between T3 and T4 tumors. Pathologic CR led to better survival than when any residual disease was present (P = .02). Disease progression occurred mainly in distant sites.ConclusionThis combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.

Comparative study of prophylactic cranial irradiation in patients with small cell lung cancer achieving a complete response: a long-term follow-up result

Lung Cancer ◽  
1993 ◽  
Vol 10 (1-2) ◽  
pp. 47-54 ◽  
Author(s):  
Taisuke Ohonoshi ◽  
Hiroshi Ueoka ◽  
Shin Kawahara ◽  
Katsuyuki Kiura ◽  
Haruhito Kamei ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Complete Response ◽  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Small Cell ◽  
Small Cell Lung ◽  
Long Term Follow Up

Adjuvant vinorelbine and cisplatin after complete resection of stage II and III non-small cell lung cancer: long-term follow-up of our study of Japanese patients

Surgery Today ◽  
2018 ◽  
Vol 48 (7) ◽  
pp. 687-694 ◽  
Author(s):  
Makoto Sonobe ◽  
Masatsugu Hamaji ◽  
Hideki Motoyama ◽  
Toshi Menju ◽  
Akihiro Aoyama ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Japanese Patients ◽  
Complete Resection ◽  
Small Cell ◽  
Small Cell Lung ◽  
Long Term Follow Up

2150 Long term observations in combined modality therapy for limited stage small cell lung cancer

1997 ◽  
Vol 39 (2) ◽  
pp. 315
Author(s):  
Philip J. Colletier ◽  
Ritsuko Komaki ◽  
Randi A. Schea ◽  
Pamela Allen ◽  
James D. Cox
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Combined Modality Therapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Limited Stage ◽  
Combined Modality

Surgically Proven Complete Response of Stage III Non-Small Cell Lung Cancer after Cisplatin-Enhanced Radiotherapy. Clinical Implications and Long-Term Results

2003 ◽  
Vol 89 (1) ◽  
pp. 16-19
Author(s):  
Amedeo Vittorio Bedini ◽  
Luca Tavecchio ◽  
Vincenzo Delledonne ◽  
Stefano Michele Andreani
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Small Cell ◽  
Stage Iii ◽  
Clinical Implications ◽  
Small Cell Lung

Aims and Background Pathologic complete response in locally advanced non-small cell lung cancer is the main end point of combined therapies (chemotherapy and/or radiotherapy). Surgery after an induction treatment can improve local control, allowing the histologic assessment of treatment activity by means of resection or extensive biopsies. Methods Thirty patients surgically assessed without viable tumor after concurrent radiotherapy and continuous infusion of low-dose cisplatin, owing to an initially unresectable stage III non-small-cell lung cancer, were the object of evaluation to assess clinical implications, short- and long-term surgical results. Results The specificity rate of the preoperative restaging was 36.6%. The surgical procedures consisted of 22 resections and of extensive biopsies in 8 cases. The operative mortality was 4% (1/25) for procedures other than right pneumonectomy (3/5). No patient received postoperative chemotherapy. Eleven distant progressions, 4 local recurrences, and 4 new primary tumors were assessed as initial failures. The 8-year overall survival was 36%. Conclusions Pathologic complete response after cisplatin-enhanced radiotherapy cannot be satisfactorily assessed by clinical means. Surgery is required to obtain a reliable evaluation; however, right pneumonectomy should be contraindicated because of prohibitive risk. Although an effective local treatment can cure patients with advanced stage III disease, the addition of chemotherapy seems advisable to improve tumor relapse control.

Maintenance chemotherapy in small-cell lung cancer: long-term results of a randomized trial. European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group.

1993 ◽  
Vol 11 (7) ◽  
pp. 1230-1240 ◽  
Author(s):  
G Giaccone ◽  
O Dalesio ◽  
G J McVie ◽  
A Kirkpatrick ◽  
P E Postmus ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Complete Response ◽  
Small Cell ◽  
Long Term Results ◽  
Maintenance Chemotherapy ◽  
Small Cell Lung ◽  
To Receive

PURPOSE The present study investigates the role of short chemotherapy (five cycles) versus prolonged (12 cycles) chemotherapy in small-cell lung cancer (SCLC). PATIENTS AND METHODS Six hundred eighty-seven patients with SCLC were registered in a multicenter study to receive five cycles of chemotherapy consisting of cyclophosphamide 1 g/m2 on day 1, doxorubicin 45 mg/m2 on day 1, and etoposide 100 mg/m2 on days 1, 3 and 5 (CDE), every 3 weeks. Four hundred thirty-four nonprogressing patients after five cycles of chemotherapy were randomized either to receive seven further cycles of the same chemotherapy or to follow-up. RESULTS The response rate of 585 assessable patients was 79%, with 36% attaining a complete response. Toxicity was mainly hematologic, with 16 toxic deaths (2.4% of all eligible patients), 13 of which were due to sepsis. Median survival time from registration of all patients was 326 days (396 and 267 days for limited and extensive disease, respectively) with 3.2% of patients alive at 5 years. No difference in survival between the two arms was observed, with the same number of 5-year survivors in both arms. The patients randomized to the maintenance arm had a progression-free survival (PFS) duration approximately 2 months longer than the patients randomized to follow-up (median of 177 days v 114 days from randomization; P = .0004). Among patients with a partial response who were randomized to receive maintenance chemotherapy, 12 achieved a complete response after 12 cycles. More patients in the follow-up arm than in the maintenance arm received subsequent treatment on progression and responded more frequently to that treatment. Twelve patients developed second malignancies (seven non-small-cell lung cancers). CONCLUSION Prolonged chemotherapy does not offer a better chance of cure than short chemotherapy (five cycles) and does not prolong survival in patients with SCLC. Short, combination chemotherapy appears to be a reasonable choice for standard treatment of SCLC and for attempts to improve the cure rate of this disease.

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