Combined Chemotherapy and Radiotherapy Followed by Surgery for Non-small Cell Lung Cancer

Ninety-one patients with locally advanced non-small cell lung cancer were treated with cisplatin-containing chemotherapy which was combined before and after radiotherapy (50-70Gy). Because local failure occured in 23 out of 68 patients who had responded to the combined therapy, it was anticipated that surgical rescue may prolong survival. Ten responders underwent thoracotomy. There were 4 with stage IIIA and 6 with stage III B, 8 squamous cell carcinomas, one large cell carcinoma and one adenosquamous carcinoma. Complete tumor resection was accomplished in all patients with 3 pneumonectomies and 7 lobectomies. Four patients had pathologically complete responses with no cancer cells detected in the resected specimen. Histological examination in one patient revealed that squamous cell carcinoma should be corrected to small cell carcinoma. The only one death was due to bleeding after the pneumonectomy. Subsequent CNS relapse developed in 2 other patients, both of whom are alive 28 and 18 months after surgery. The other 7 patients remain free of disease with a median follow up of 28 months (18-55 months).