Multimodality therapy of patients with stage IIIA, N2 non-small-cell lung cancer. Impact of preoperative chemotherapy on resectability and downstaging
To assess the effect of neoadjuvant platinum-based chemotherapy on resectability, stage of disease at resection, and patterns of recurrence and survival in patients with IIIA, N2 non-small-cell lung cancer, we examined the first 60 patients treated with neoadjuvant chemotherapy followed by attempted...
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Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 1993-10, Vol.106 (4), p.696-702 |
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description | To assess the effect of neoadjuvant platinum-based chemotherapy on resectability, stage of disease at resection, and patterns of recurrence and survival in patients with IIIA, N2 non-small-cell lung cancer, we examined the first 60 patients treated with neoadjuvant chemotherapy followed by attempted resection in our institution. Of 67 patients identified, 7 patients were ineligible because of comorbidities, 3 patients refused chemotherapy, and 1 consented but died before treatment. Fifty-six received neoadjuvant chemotherapy. Complications of chemotherapy were minor, with no deaths. Fifty-four patients had thoracotomy; 75% (n = 42) had complete resection and 25% (n = 14) had unresectable lesions. One postoperative death occurred (2%). Pathologic review of specimens and nodal groups revealed that 41% (n = 23) were downstaged, 39% (n = 22) remained stage IIIA, and 19% (n = 11) progressed. Squamous histologic type was predictive of resectability, 18 of 20 patients having resectable squamous cell tumors (p < 0.05). Actuarial survivals at 1 and 2 years were 74% and 52%, respectively. In patients with resectable tumors survivals at 1 and 2 years were 85% and 67%, respectively. For those with unresectable lesions, survivals were 43% and 14%. Relapse-free survivals at 1 and 2 years for patients with resectable lesions were 70% and 42%, respectively. Relapses were local in 25% (n = 4), at a distant site only in 50% (n = 8), combined local and distant in 25% (n = 4). Distant relapse occurred in the central nervous system only in 7 of 8 patients (88%). Complete resectability was highly predictive of improved survival (p < 0.0002). Weight loss did not affect resectability but was associated with decreased survival (p < 0.003). Neoadjuvant chemotherapy appears to improve resectability and to pathologically downstage N2 non-small-cell lung cancer from stage IIIA. Multiinstitutional randomized trials are needed to further demonstrate the efficacy of this approach. |
doi_str_mv | 10.1016/S0022-5223(19)33713-4 |
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Impact of preoperative chemotherapy on resectability and downstaging</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Kirn, DH ; Lynch, TJ ; Mentzer, SJ ; Lee, TH ; Strauss, GM ; Elias, AD ; Skarin, AT ; Sugarbaker, DJ</creator><creatorcontrib>Kirn, DH ; Lynch, TJ ; Mentzer, SJ ; Lee, TH ; Strauss, GM ; Elias, AD ; Skarin, AT ; Sugarbaker, DJ</creatorcontrib><description>To assess the effect of neoadjuvant platinum-based chemotherapy on resectability, stage of disease at resection, and patterns of recurrence and survival in patients with IIIA, N2 non-small-cell lung cancer, we examined the first 60 patients treated with neoadjuvant chemotherapy followed by attempted resection in our institution. Of 67 patients identified, 7 patients were ineligible because of comorbidities, 3 patients refused chemotherapy, and 1 consented but died before treatment. Fifty-six received neoadjuvant chemotherapy. Complications of chemotherapy were minor, with no deaths. Fifty-four patients had thoracotomy; 75% (n = 42) had complete resection and 25% (n = 14) had unresectable lesions. One postoperative death occurred (2%). Pathologic review of specimens and nodal groups revealed that 41% (n = 23) were downstaged, 39% (n = 22) remained stage IIIA, and 19% (n = 11) progressed. Squamous histologic type was predictive of resectability, 18 of 20 patients having resectable squamous cell tumors (p < 0.05). Actuarial survivals at 1 and 2 years were 74% and 52%, respectively. In patients with resectable tumors survivals at 1 and 2 years were 85% and 67%, respectively. For those with unresectable lesions, survivals were 43% and 14%. Relapse-free survivals at 1 and 2 years for patients with resectable lesions were 70% and 42%, respectively. Relapses were local in 25% (n = 4), at a distant site only in 50% (n = 8), combined local and distant in 25% (n = 4). Distant relapse occurred in the central nervous system only in 7 of 8 patients (88%). Complete resectability was highly predictive of improved survival (p < 0.0002). Weight loss did not affect resectability but was associated with decreased survival (p < 0.003). Neoadjuvant chemotherapy appears to improve resectability and to pathologically downstage N2 non-small-cell lung cancer from stage IIIA. Multiinstitutional randomized trials are needed to further demonstrate the efficacy of this approach.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/S0022-5223(19)33713-4</identifier><identifier>PMID: 8412265</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>Philadelphia, PA: AATS/WTSA</publisher><subject>Adenocarcinoma - drug therapy ; Adenocarcinoma - radiotherapy ; Adenocarcinoma - surgery ; Adult ; Aged ; Antineoplastic agents ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Biological and medical sciences ; Carcinoma, Non-Small-Cell Lung - drug therapy ; Carcinoma, Non-Small-Cell Lung - radiotherapy ; Carcinoma, Non-Small-Cell Lung - surgery ; Chemotherapy, Adjuvant ; Cisplatin - administration & dosage ; Combined treatments (chemotherapy of immunotherapy associated with an other treatment) ; Female ; Humans ; Lung Neoplasms - drug therapy ; Lung Neoplasms - radiotherapy ; Lung Neoplasms - surgery ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Pneumonectomy ; Survival Analysis</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 1993-10, Vol.106 (4), p.696-702</ispartof><rights>1994 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3777931$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8412265$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirn, DH</creatorcontrib><creatorcontrib>Lynch, TJ</creatorcontrib><creatorcontrib>Mentzer, SJ</creatorcontrib><creatorcontrib>Lee, TH</creatorcontrib><creatorcontrib>Strauss, GM</creatorcontrib><creatorcontrib>Elias, AD</creatorcontrib><creatorcontrib>Skarin, AT</creatorcontrib><creatorcontrib>Sugarbaker, DJ</creatorcontrib><title>Multimodality therapy of patients with stage IIIA, N2 non-small-cell lung cancer. Impact of preoperative chemotherapy on resectability and downstaging</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>To assess the effect of neoadjuvant platinum-based chemotherapy on resectability, stage of disease at resection, and patterns of recurrence and survival in patients with IIIA, N2 non-small-cell lung cancer, we examined the first 60 patients treated with neoadjuvant chemotherapy followed by attempted resection in our institution. Of 67 patients identified, 7 patients were ineligible because of comorbidities, 3 patients refused chemotherapy, and 1 consented but died before treatment. Fifty-six received neoadjuvant chemotherapy. Complications of chemotherapy were minor, with no deaths. Fifty-four patients had thoracotomy; 75% (n = 42) had complete resection and 25% (n = 14) had unresectable lesions. One postoperative death occurred (2%). Pathologic review of specimens and nodal groups revealed that 41% (n = 23) were downstaged, 39% (n = 22) remained stage IIIA, and 19% (n = 11) progressed. Squamous histologic type was predictive of resectability, 18 of 20 patients having resectable squamous cell tumors (p < 0.05). Actuarial survivals at 1 and 2 years were 74% and 52%, respectively. In patients with resectable tumors survivals at 1 and 2 years were 85% and 67%, respectively. For those with unresectable lesions, survivals were 43% and 14%. Relapse-free survivals at 1 and 2 years for patients with resectable lesions were 70% and 42%, respectively. Relapses were local in 25% (n = 4), at a distant site only in 50% (n = 8), combined local and distant in 25% (n = 4). Distant relapse occurred in the central nervous system only in 7 of 8 patients (88%). Complete resectability was highly predictive of improved survival (p < 0.0002). Weight loss did not affect resectability but was associated with decreased survival (p < 0.003). Neoadjuvant chemotherapy appears to improve resectability and to pathologically downstage N2 non-small-cell lung cancer from stage IIIA. Multiinstitutional randomized trials are needed to further demonstrate the efficacy of this approach.</description><subject>Adenocarcinoma - drug therapy</subject><subject>Adenocarcinoma - radiotherapy</subject><subject>Adenocarcinoma - surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic agents</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Non-Small-Cell Lung - drug therapy</subject><subject>Carcinoma, Non-Small-Cell Lung - radiotherapy</subject><subject>Carcinoma, Non-Small-Cell Lung - surgery</subject><subject>Chemotherapy, Adjuvant</subject><subject>Cisplatin - administration & dosage</subject><subject>Combined treatments (chemotherapy of immunotherapy associated with an other treatment)</subject><subject>Female</subject><subject>Humans</subject><subject>Lung Neoplasms - drug therapy</subject><subject>Lung Neoplasms - radiotherapy</subject><subject>Lung Neoplasms - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Pneumonectomy</subject><subject>Survival Analysis</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kM1u1DAUhS0EKkPhESp5gfiRmnLtOE6yrCqgkUpZABK76Ma-M3GVOGnsMJoX6fOSmY5mdRfn03d0D2MXAq4ECP3lF4CUSSZl-kmUn9M0F2miXrCVgDJPdJH9fclWJ-Q1exPCAwDkIMozdlYoIaXOVuzpx9xF1w8WOxd3PLY04bjjw5qPGB35GPjWxZaHiBviVVVdX_J7yf3gk9Bj1yWGuo53s99wg97QdMWrfkQTD4qJhnERRvePuGmpH05-zycKZCI27lCM3nI7bP2-x_nNW_ZqjV2gd8d7zv58-_r75ja5-_m9urm-S1qp85gQWCw0StICAFFJAp1hKbRATTkqg0o1YFUjDGQF2LUQirRNpdG2yaxJz9mHZ-84DY8zhVj3LuxfQk_DHOpcA2SqEAt4cQTnpidbj5PrcdrVxyGX_P0xx2CwW0_LGC6csDTP8zLdaz4-Y63btFs3UX1YcZGK-iGaIEDXqtalTv8D9gqTMg</recordid><startdate>19931001</startdate><enddate>19931001</enddate><creator>Kirn, DH</creator><creator>Lynch, TJ</creator><creator>Mentzer, SJ</creator><creator>Lee, TH</creator><creator>Strauss, GM</creator><creator>Elias, AD</creator><creator>Skarin, AT</creator><creator>Sugarbaker, DJ</creator><general>AATS/WTSA</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19931001</creationdate><title>Multimodality therapy of patients with stage IIIA, N2 non-small-cell lung cancer. Impact of preoperative chemotherapy on resectability and downstaging</title><author>Kirn, DH ; Lynch, TJ ; Mentzer, SJ ; Lee, TH ; Strauss, GM ; Elias, AD ; Skarin, AT ; Sugarbaker, DJ</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h267t-e0da86a2e6100aa42e065a9161a6e7a4ca44b0d4b1c0580df114e6d32c6db5dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Adenocarcinoma - drug therapy</topic><topic>Adenocarcinoma - radiotherapy</topic><topic>Adenocarcinoma - surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic agents</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Carcinoma, Non-Small-Cell Lung - drug therapy</topic><topic>Carcinoma, Non-Small-Cell Lung - radiotherapy</topic><topic>Carcinoma, Non-Small-Cell Lung - surgery</topic><topic>Chemotherapy, Adjuvant</topic><topic>Cisplatin - administration & dosage</topic><topic>Combined treatments (chemotherapy of immunotherapy associated with an other treatment)</topic><topic>Female</topic><topic>Humans</topic><topic>Lung Neoplasms - drug therapy</topic><topic>Lung Neoplasms - radiotherapy</topic><topic>Lung Neoplasms - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Pneumonectomy</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kirn, DH</creatorcontrib><creatorcontrib>Lynch, TJ</creatorcontrib><creatorcontrib>Mentzer, SJ</creatorcontrib><creatorcontrib>Lee, TH</creatorcontrib><creatorcontrib>Strauss, GM</creatorcontrib><creatorcontrib>Elias, AD</creatorcontrib><creatorcontrib>Skarin, AT</creatorcontrib><creatorcontrib>Sugarbaker, DJ</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirn, DH</au><au>Lynch, TJ</au><au>Mentzer, SJ</au><au>Lee, TH</au><au>Strauss, GM</au><au>Elias, AD</au><au>Skarin, AT</au><au>Sugarbaker, DJ</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multimodality therapy of patients with stage IIIA, N2 non-small-cell lung cancer. Impact of preoperative chemotherapy on resectability and downstaging</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>1993-10-01</date><risdate>1993</risdate><volume>106</volume><issue>4</issue><spage>696</spage><epage>702</epage><pages>696-702</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>To assess the effect of neoadjuvant platinum-based chemotherapy on resectability, stage of disease at resection, and patterns of recurrence and survival in patients with IIIA, N2 non-small-cell lung cancer, we examined the first 60 patients treated with neoadjuvant chemotherapy followed by attempted resection in our institution. Of 67 patients identified, 7 patients were ineligible because of comorbidities, 3 patients refused chemotherapy, and 1 consented but died before treatment. Fifty-six received neoadjuvant chemotherapy. Complications of chemotherapy were minor, with no deaths. Fifty-four patients had thoracotomy; 75% (n = 42) had complete resection and 25% (n = 14) had unresectable lesions. One postoperative death occurred (2%). Pathologic review of specimens and nodal groups revealed that 41% (n = 23) were downstaged, 39% (n = 22) remained stage IIIA, and 19% (n = 11) progressed. Squamous histologic type was predictive of resectability, 18 of 20 patients having resectable squamous cell tumors (p < 0.05). Actuarial survivals at 1 and 2 years were 74% and 52%, respectively. In patients with resectable tumors survivals at 1 and 2 years were 85% and 67%, respectively. For those with unresectable lesions, survivals were 43% and 14%. Relapse-free survivals at 1 and 2 years for patients with resectable lesions were 70% and 42%, respectively. Relapses were local in 25% (n = 4), at a distant site only in 50% (n = 8), combined local and distant in 25% (n = 4). Distant relapse occurred in the central nervous system only in 7 of 8 patients (88%). Complete resectability was highly predictive of improved survival (p < 0.0002). Weight loss did not affect resectability but was associated with decreased survival (p < 0.003). Neoadjuvant chemotherapy appears to improve resectability and to pathologically downstage N2 non-small-cell lung cancer from stage IIIA. Multiinstitutional randomized trials are needed to further demonstrate the efficacy of this approach.</abstract><cop>Philadelphia, PA</cop><pub>AATS/WTSA</pub><pmid>8412265</pmid><doi>10.1016/S0022-5223(19)33713-4</doi><tpages>7</tpages></addata></record> |
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subjects | Adenocarcinoma - drug therapy Adenocarcinoma - radiotherapy Adenocarcinoma - surgery Adult Aged Antineoplastic agents Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biological and medical sciences Carcinoma, Non-Small-Cell Lung - drug therapy Carcinoma, Non-Small-Cell Lung - radiotherapy Carcinoma, Non-Small-Cell Lung - surgery Chemotherapy, Adjuvant Cisplatin - administration & dosage Combined treatments (chemotherapy of immunotherapy associated with an other treatment) Female Humans Lung Neoplasms - drug therapy Lung Neoplasms - radiotherapy Lung Neoplasms - surgery Male Medical sciences Middle Aged Pharmacology. Drug treatments Pneumonectomy Survival Analysis |
title | Multimodality therapy of patients with stage IIIA, N2 non-small-cell lung cancer. Impact of preoperative chemotherapy on resectability and downstaging |
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