Pourel N et al. - In a study to confirm feasibility and pathological response rates after induction chemoradiation (CRT), it was shown that surgery was feasible after induction chemoradiation, particularly lobectomy in PS 0–1, stage IIB (Pancoast)/III NSCLC pts but pneumonectomy carries a high risk of postoperative death. Pathological response to induction chemoradiation was complete in 39.5% of pts and was a significant predictive factor of overall survival Methods
Pts were selected according to functional and resectability criteria
Induction treatment comprised 3D conformal 4500 cGy radiotherapy delivered to the primary tumor and pathologic hilar and/or mediastinal lymph nodes on CT scan with an extra-margin of 1–1.5 cm
Concurrent chemotherapy regimen was cisplatinum 20 mg/m2 d1–d5 and etoposide 50 mg/m2 d1–d5, d1–5 d29–33
Within 3–4 weeks after CRT completion, operability was re-assessed accordingly
Surgery was performed 4–6 weeks after CRT completion in pts deemed resectable
Results
107 pts were initially selected for treatment and received induction chemoradiation
After preoperative evaluation, 72 pts had a thoracotomy and all but 1 had a macroscopic complete resection
During the 3-month postoperative time, 5 pts died, 4 after pneumonectomy
Analysis of tumoral samples showed a pathological complete response rate or microscopic residual foci of 39.5%
Median follow-up time was 22.3 months, 2-year and 3-year overall survival rates were 55% and 40%, respectively for all the intention-to-treat population, 62% and 51% for 71 resected pts, 41% and 16% for 36 non-resected pts
Surgical resection and tumoral necrosis >50% were the most pertinent predictive factors of the risk of death
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