Neoadjuvant concurrent radiochemotherapy in locally advanced (IIIA–IIIB) non-small-cell lung cancer: long-term results according to downstaging

Trodella, Lucio; Granone, Pierluigi; Valente, Salvatore; Margaritora, Stefano; Macis, Giuseppe; Cesario, Alfredo; D’Angelillo, Rolando Maria; Valentini, Vincenzo; Corbo, Giuseppe Maria; Porziella, Venanzio; Ramella, Sara; Tonini, Giuseppe; Galetta, Domenico; Ciresa, M.; Vincenzi, Bruno; Cellini, Numa

doi:10.1093/annonc/mdh099

Cited by 57 publications

(53 citation statements)

References 32 publications

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“…These results compare favorably with those of previous trials of trimodality therapy in patients with locally advanced NSCLC, although comparing these results with those of other studies is difficult because of the inclusion of patients with different prognostic factors (8)(9)(10)(11)(12). In all of these studies, the response rates to induction chemoradiotherapy have ranged from 59 to 81%, the complete surgical resection rates have ranged from 45 to 81%, MSTs have ranged from 13 to 25 months, and survival rates at 2 years have ranged from 26 to 66% (8)(9)(10)(11)(12). Additionally, previous studies have reported that downstaging is correlated with rates of survival and distant recurrence (12,18).…”

Section: Discussionsupporting

confidence: 78%

“…Additionally, previous studies have reported that downstaging is correlated with rates of survival and distant recurrence (12,18). In previous studies, the rate of downstaging has ranged from 12 to 33% (12,13). In the present study, the rate of downstaging was 39.1% among all patients and 64.3% among patients undergoing thoracotomy.…”

Section: Discussionsupporting

confidence: 55%

“…In all of these studies, the response rates to induction chemoradiotherapy have ranged from 59 to 81%, the complete surgical resection rates have ranged from 45 to 81%, MSTs have ranged from 13 to 25 months, and survival rates at 2 years have ranged from 26 to 66% (8)(9)(10)(11)(12). Additionally, previous studies have reported that downstaging is correlated with rates of survival and distant recurrence (12,18). In previous studies, the rate of downstaging has ranged from 12 to 33% (12,13).…”

Section: Discussionmentioning

confidence: 99%

“…Several combined treatment modalities have been used in an attempt to decrease the high rates of local recurrence and distant metastasis (17). Some phase II studies of induction chemoradiotherapy followed by surgery have obtained promising results for patients with locally advanced NSCLC (8)(9)(10)(11)(12). However, there is no evidence that induction chemoradiotherapy followed by surgery is superior to chemoradiotherapy or surgery alone.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, some phase II studies have examined induction chemoradiotherapy followed by surgery for patients with stage IIIA or IIIB NSCLC. These studies have shown promising results for patients with locally advanced NSCLC (8)(9)(10)(11)(12). However, the Intergroup 0139 trial has found that median progressionfree survival was significantly longer with chemoradiotherapy followed by surgery than with chemoradiotherapy alone for patients with pathologically proven N2 stage IIIA but that overall survival did not differ (13).…”

Section: Introductionmentioning

confidence: 99%

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Induction chemoradiotherapy followed by surgery for locally advanced non-small cell lung cancer

Kusumoto

Hirose²,

Fukayama³

et al. 2009

Oncol Rep

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Abstract. We examined the efficacy and toxicity of a divided schedule of cisplatin and vinorelbine with concurrent radiotherapy followed by surgery in patients with locally advanced non-small cell lung cancer (NSCLC). Patients with clinical stage IIIA or IIIB NSCLC were eligible if they had a performance status of 0 or 1, were 75 years or younger, and had adequate organ function. Patients were treated with cisplatin (40 mg/m 2 ) and vinorelbine (20 mg/m 2 ) on days 1 and 8 every 3 weeks. Thoracic radiotherapy (2 Gy per fraction; total dose, 40 Gy) was given concurrently. Surgical resection was performed after induction therapy had been completed. If disease was considered clinically inoperable after induction therapy, patients received 2 additional cycles of the chemotherapy and 20 Gy of additional radiotherapy. Twenty-three patients (20 men and 3 women; median age, 63 years; age range, 45-72 years) were enrolled. The overall response rate was 78.3%. Although grade 3-4 toxicities included neutropenia in 95.7% of patients and anemia in 39.1%, no grade 3-4 radiation pneumonitis or esophagitis occurred. Thirteen patients (56.5%) underwent thoracotomy and complete resection. There were no treatment-related deaths. The median survival time was 36 months (range, 4-78 months), the 2-year survival rate was 74%, and the median time to disease progression was 15 months (range, 2-59 months). This trimodality therapy is effective and well tolerated and is an acceptable therapeutic option for patients with locally advanced NSCLC.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Induction chemoradiotherapy followed by surgery for locally advanced non-small cell lung cancer

Kusumoto

Hirose²,

Fukayama³

et al. 2009

Oncol Rep

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Dose escalation of gemcitabine concomitant with radiation and cisplatin for nonsmall cell lung cancer

Momm

Kaden

Tannock

et al. 2010

Cancer

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BACKGROUND:The current study was conducted to evaluate the maximum tolerable dose of weekly gemcitabine administered simultaneously with radiation and cisplatin in patients with locally advanced nonsmall cell lung cancer (NSCLC). METHODS: Patients with stage IIIA/B NSCLC received concurrently 63 grays radiation and 20 mg/m 2 cisplatin Day 1 to 3 in Weeks 1 and 5, plus weekly gemcitabine at escalating doses (150-700 mg/m 2 ) on Fridays after radiation to avoid radiosensitization. The authors assessed dose-limiting toxicities according to Common Toxicity Criteria. The primary endpoint was maximum tolerated dose (MTD) of gemcitabine. Tumor resectability, survival, and disease-free survival (DFS) were also determined. RESULTS: Forty-two patients were accrued, of whom 95% received radiation and 66% cisplatin as above. Weekly doses of gemcitabine were escalated to 700 mg/m 2 . Grade 3 dysphagia and 1 case of fatal, probably treatment-related pulmonary deterioration established the MTD of gemcitabine at 550 mg/m 2 weekly. Twenty-five patients underwent surgery, and histopathological complete regression was documented in 26% of these patients. Overall, median actuarial survival and DFS were 23.8 and 12.4 months, respectively. CONCLUSIONS: Gemcitabine at doses up to 550 mg/m 2 weekly can be given simultaneously with radiation and cisplatin to patients with locally advanced NSCLC. Radical resection thereafter is feasible. The impact of this aggressive therapy should be evaluated further. Cancer 2010;116:4833-9.

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Hyperfractionated Irradiation with 3 Cycles of Induction Chemotherapy in Stage IIIA‐N2 Lung Cancer

et al. 2012

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Neoadjuvant concurrent radiochemotherapy in locally advanced (IIIA–IIIB) non-small-cell lung cancer: long-term results according to downstaging

Abstract: Neoadjuvant radiochemotherapy is feasible with good pathological DS results. Pathological downstaging was confirmed to have high predictive value. Its use is suggested in the short-term evaluation of induction protocols efficacy in locally advanced NSCLC.

Cited by 57 publications

References 32 publications

Induction chemoradiotherapy followed by surgery for locally advanced non-small cell lung cancer

Induction chemoradiotherapy followed by surgery for locally advanced non-small cell lung cancer

Dose escalation of gemcitabine concomitant with radiation and cisplatin for nonsmall cell lung cancer

Hyperfractionated Irradiation with 3 Cycles of Induction Chemotherapy in Stage IIIA‐N2 Lung Cancer

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