Multimodality Treatement in Patients with Clinical Stage IIIA NSCLS

BACKGROUND: To find out effectiveness of multimodality treatments based on induction chemotherapy(CTx) in patients with clinical stage IIIA NSCLC0aMETHODS: From 1997 to 2002, 74 patients with clinical stage IIIA NSCLC underwent induction CTx at the hospital of Chungnam National University. Induction CTx included above two cycles of cisplatin-based regimens(ectoposide, gemcitabine, vinorelbine, or taxol) followed by tumor evaluation. In 30 complete resection group, additional 4500-5000cGy radiotherapy(RTx) was delivered in 15 patients with pathologic nodal metastasis. 29 out of 44 patients who were unresectable disease, refusal of operation, and incomplete resection were followed by 60-70Gy RTx in local treatment. Additional 1-3 cycle CTx were done in case of induction CTx responders in both local treatment groups. 0aRESULTS: Induction CTx response rate were 44.6%(complete remission 1.4% & partial response 43.2%) and there was no difference of response rate by regimens(py 33 out of resectable 55 ones(including initial resectable 37 patients) were performed by surgical treatment because of 13 refusal of surgery by themselves and 9 poor predicted reserve lung function. There were 30(40.5%) patients with complete resection, 2(2.6%) persons with incomplete resection, and 1(1.3%) person with open & closure. Response rate in 27 ones with chest RTx out of non-operation group was 4.8% CR and 11.9% PR. In complete resection group, relapse free interval was 13.6 months and 2 year recur rate was 52%. In non-complete resection(incomplete resection or non-operation) group, disease progression free interval was 11.2 months and 2 year disease progression rate was 66.7%. Median survival time of induction CTx 74 patients with IIIA NSCLC was 25.1months. When compared complete resection group with non-complete resection group, the median survival time was 31.7 and 23.4months(pve RTx subgroup significantly improved the 2-year local control rate(0% vs. 40%, ps, especially followed by complete resection, but overall survival by any local treatment(surgical resection or RTx) was low. Additional studies should be needed to analysis data for appropriate patient selection, new chemotherapy regimens and the time when should RTx be initiated

keywords: Multimodality Treatement, Stage IIIA, NSCLC, Induction Chemotherapy

Reference

(2002) 인구동태 신고에 의한 집계, 통계청

(2001) 한국중앙암등록 사업 연례 보고서,

(1999) Preresectional chemothrapy in stage IIIA non-small-cell lung-cancer:a 7-year assessment of a randomized controlled trial,

(1998) Long- term follow-up of patients enrolled in a randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer,

(1992) Randomized trial of neoadjuvant therapy for lung cancer: Interim analysis,

(2002) Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0) II, and IIIa non-small-cell lung cancer,

(2003) American Colleage of chest physians Treatment of stage IIIA non-small cell lung cancer,

(1999) Randomized phase III study of gemcitabine-cisplatin versus etoposide- cisplatin in the treatment of locally advanced or metastatic non-small-cell lung cancer,

(1999) Gemcitabine and cisplatin versus mitomycin, ifosfamide, and cisplatin in advanced non-small-cell lung cancer: A randomized phase III study of the Italian Lung Cancer Project,

10.

(2000) Gemcitabine and cisplatin as induction regimen for patients with biopsy-proven stage IIIA N2 non-small-cell lung cancer: a phase II study of the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group (EORTC 08955). ,

11.

(2002) Neoadjuvant chemotherapy with gemcitabine and cisplatin in stage IIIA/B non-small cell lung cancer,

12.

(2002) Gemcitabine and cisplatin in a multi- modality treatment for locally advanced non-small cell lung cancer,

13.

(2003) Resected non-small cell lung cancer: need for adjuvant lymph node treatment? From hope to reality,

14.

(2002) Use of postoperative radiotherapy for node-positive non-small-cell lung cancer,

15.

(1998) Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials,

16.

(2004) Equivalent outcome of patients with clinical Stage IIIA non-small-cell lung cancer treated with concurrent chemoradiation compared with induction chemotherapy followed by surgical resection,

17.

(1996) Improved survival in stage III non- small-cell lung cancer seven-year follow-up of cancer and leukemia group B(CALGB) 8433 trial,

18.

Radiotherapy alone versus combined chemotherapy and radiotherapy in nonresectable non-small-cell lung cancer: first analysis of a randomized trial in 353 patients,

19.

(1987) Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy.Report by the Radiation Therapy On- cology Group,

20.

(1995) Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stages IIIa and IIIb nonsmall cell lung cancer,

21.

(2000) A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIA non-small-cell lung cancer,

22.

(2003) Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer,

23.

(2004) International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin- based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer,

바로가기메뉴

Article Contents

Vol.57 No.6

Multimodality Treatement in Patients with Clinical Stage IIIA NSCLS

Abstract

Reference

Tuberculosis & Respiratory Diseases