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Eur J Cardiothorac Surg 1998;13:1-12
© 1998 Elsevier Science NL
Review article |
a Department of Pulmonology (Respiratory Tumor Unit), University Hospital Gasthuisberg, Catholic University, Herestraat 49, B-3000 Leuven, Belgium
b Department of Thoracic Surgery, University Hospital Gasthuisberg, Catholic University, Herestraat 49, B-3000 Leuven, Belgium
c Department of Radiotherapy, University Hospital Gasthuisberg, Catholic University, Herestraat 49, B-3000 Leuven, Belgium
Received 20 May 1997; received in revised form 25 August 1997; accepted 23 September 1997.
Corresponding author. Tel.: +32 16 346802; fax: +32 16 346803; e-mail: Johan.Vansteenkiste@uz.kuleuven.ac.be
Background: Surgical exploration in mediastinoscopy proven N2 non-small cell lung cancer (NSCLC) is unrewarding. Theoretical concepts suggest a beneficial role for preoperative induction treatment. The solidity of the therapeutic results with this approach in the currently available data is examined. Methods: Literature on induction therapy followed by surgical exploration, consisting of randomized reports and phase II reports meeting some essential criteria, are reviewed. Results: Of the twenty-four analyzed phase II studies, thirteen lack adequate surgical staging. Stratification for various important prognostic factors in N2 disease is missing in many instances. Results with induction with a cisplatinum dose of less than 80 mg/m2 seem to be inferior. The use of mitomycin-C in patients scheduled for lung resection or irradiation deserves caution. No evident difference in efficacy between induction chemotherapy or chemo-radiotherapy is suggested, but toxicity and mortality appear to be somewhat higher with chemo-radiotherapy. Pathological complete response is mainly found after an at least partial clinical response. Effect on survival in non-controlled phase II studies and small randomized reports is encouraging. Conclusions: the role of chemotherapy induction in improving the long-term survival of N2 NSCLC is promising, but needs to be confirmed by large multi-center randomized data. Adequate surgical staging and attention to important prognostic factors in N2 disease should minimize the numerous institution based differences interfering in the currently available non-controlled studies.
Key Words: Non-small cell lung carcinoma • Combined modality treatment • Induction chemotherapy • Lung surgery • N2 disease
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