HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Voltolini, L. Articles by Gotti, G. Search for Related Content PubMed PubMed Citation Articles by Voltolini, L. Articles by Gotti, G. Related Collections Lung - cancer

Eur J Cardiothorac Surg 2001;20:1106-1112
© 2001 Elsevier Science NL

Results of induction chemotherapy followed by surgical resection in patients with stage IIIA (N2) non-small cell lung cancer: the importance of the nodal down-staging after chemotherapy

Thoracic Surgery Unit, University Hospital of Siena, Viale Bracci n. 1, 53100 Siena, Italy

Received 10 October 2000; received in revised form 9 May 2001; accepted 16 July 2001.

Corresponding author. Tel.: +39-0577-585731; fax: +39-0577-586168
e-mail: lucavolt{at}jumpy.it

Objective: Chemotherapy of stage IIIA non-small cell lung cancer (NSCLC) using second generation, cisplatin-based combinations has shown to improve the results; however, the distant relapses remain the major problem. Encouraging results in the treatment of stage IV NSCLC with newer agents (gemcitabine, placlitaxel) has encouraged us to use them in stage III. The aim of this study was to assess feasibility and efficacy of induction chemotherapy with cisplatin and gemcitabine followed by surgery for patients with stage IIIA (N2) NSCLC. Methods: From February 1996 to December 1999, 36 consecutive patients with mediastinoscopically staged N2 NSCLC received three cycles of cisplatin (80 mg/m², day 2) and gemcitabine (1200 mg/m², day 1+8) followed by surgery in responding patients. Patients with stable disease or even local progression received radiotherapy. All patients had clinical N2 disease (mediastinal lymph nodes metastasis) observed on CT scan. Results: No major complications of the chemotherapy occurred. Twenty-five patients (70%) had a clinical partial response and were surgically explored, with 18 complete resections (70%). There were no in-hospital deaths, although four (16%) major complications: bronchopleural fistula (two), respiratory insufficiency (one), oesophagospleural fistula (one). In the total group of 36 patients, 3-year survival was 20%. So far, no patient without surgery has survived longer then 27 months; median survival was 8 months. In the group of the 25 patients who underwent surgery 3-year survival was 30%, with a median survival of 21 months. The difference is significant (P=0.0027). In the surgical group, the survival of patients with down staged disease (56%) was greater than that of patients with persistent N2 disease (44%) after chemotherapy (3-year survival of 59 and 0%, respectively; P=0.0013). Conclusion: induction chemotherapy with cisplatin and gemcitabine resulted in major tumour regression in a large percentage of patients with clinical N2 disease. In responding patients both the complete respectability rate and survival were higher when compared to historical controls. Survival was significantly better in patients down-staged to a mediastinal negative disease.

Key Words: Non-small cell lung cancer • Induction chemotherapy • N2 disease • Combined modality treatment

This article has been cited by other articles:

				G. B. Ratto, R. Costa, P. Maineri, A. Alloisio, P. Bruzzi, and B. Dozin Is there a subset of patients with preoperatively diagnosed N2 non-small cell lung cancer who might benefit from surgical resection? J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 849 - 858. [Abstract] [Full Text] [PDF]

				V. Steger, T. Walles, B. Kosan, T. Walker, T. Kyriss, S. Veit, J. Dippon, and G. Friedel Trimodal Therapy for Histologically Proven N2/3 Non-Small Cell Lung Cancer: Mid-Term Results and Indicators for Survival. Ann. Thorac. Surg., June 1, 2009; 87(6): 1676 - 1683. [Abstract] [Full Text] [PDF]

				W. Zhong, X. Yang, J. Bai, J. Yang, C. Manegold, and Y. Wu Complete mediastinal lymphadenectomy: the core component of the multidisciplinary therapy in resectable non-small cell lung cancer. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 187 - 195. [Abstract] [Full Text] [PDF]

				M. De Waele, M. Serra-Mitjans, J. Hendriks, P. Lauwers, J. Belda-Sanchis, P. Van Schil, and R. Rami-Porta Accuracy and survival of repeat mediastinoscopy after induction therapy for non-small cell lung cancer in a combined series of 104 patients Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 824 - 828. [Abstract] [Full Text] [PDF]

				A. Marra, L. Hillejan, S. Fechner, and G. Stamatis Remediastinoscopy in restaging of lung cancer after induction therapy. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 843 - 849. [Abstract] [Full Text] [PDF]

				K. L. Uy, G. Darling, W. Xu, Q.-L. Yi, M. De Perrot, A. F. Pierre, T. K. Waddell, M. R. Johnston, A. Bezjak, F. A. Shepherd, et al. Improved results of induction chemoradiation before surgical intervention for selected patients with stage IIIA-N2 non-small cell lung cancer J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 188 - 193. [Abstract] [Full Text] [PDF]

				Y. Sekine, K. Yasufuku, S. Motohashi, and T. Fujisawa Triple reconstruction of pulmonary artery, superior vena cava and bronchus for lung cancer Interactive CardioVascular and Thoracic Surgery, August 1, 2006; 5(4): 509 - 510. [Abstract] [Full Text] [PDF]

				R. J. Cerfolio, A. S. Bryant, and B. Ojha Restaging patients with N2 (stage IIIa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: A prospective study J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1229 - 1235. [Abstract] [Full Text] [PDF]

				G. Plat, P. Pierard, A. Haller, J. Hutsebaut, J. Faber, M. Dusart, P. Eisendrath, J-P. Sculier, and V. Ninane Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes Eur. Respir. J., February 1, 2006; 27(2): 276 - 281. [Abstract] [Full Text] [PDF]

				M. De Waele, J. Hendriks, P. Lauwers, P. Ortmanns, W. Vanroelen, A.-M. Morel, P. Germonpre, and P. Van Schil Nodal status at repeat mediastinoscopy determines survival in non-small cell lung cancer with mediastinal nodal involvement, treated by induction therapy Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 240 - 243. [Abstract] [Full Text] [PDF]

				C. Pottgen, S. Levegrun, D. Theegarten, S. Marnitz, S. Grehl, R. Pink, W. Eberhardt, G. Stamatis, T. Gauler, G. Antoch, et al. Value of 18F-Fluoro-2-Deoxy-D-Glucose-Positron Emission Tomography/Computed Tomography in Non-Small-Cell Lung Cancer for Prediction of Pathologic Response and Times to Relapse after Neoadjuvant Chemoradiotherapy Clin. Cancer Res., January 1, 2006; 12(1): 97 - 106. [Abstract] [Full Text] [PDF]

				C. Doddoli, F. Barlesi, D. Trousse, S. Robitail, S. Yena, P. Astoul, R. Giudicelli, P. Fuentes, and P. Thomas One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: An uncertain balance between risks and benefits J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 416 - 425. [Abstract] [Full Text] [PDF]

				L. K. Shankar and D. C. Sullivan Functional Imaging in Lung Cancer J. Clin. Oncol., May 10, 2005; 23(14): 3203 - 3211. [Abstract] [Full Text] [PDF]

				J. L. Port, R. J. Korst, P. C. Lee, M. A. Levin, D. E. Becker, R. Keresztes, and N. K. Altorki Surgical Resection for Residual N2 Disease After Induction Chemotherapy Ann. Thorac. Surg., May 1, 2005; 79(5): 1686 - 1690. [Abstract] [Full Text] [PDF]

				A. Iwasaki, T. Shirakusa, T. Maekawa, S. Enatsu, and S. Maekawa Clinical evaluation of systemic inflammatory response syndrome (SIRS) in advanced lung cancer (T3 and T4) with surgical resection Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 14 - 18. [Abstract] [Full Text] [PDF]

				N. Lorent, P. De Leyn, Y. Lievens, E. Verbeken, K. Nackaerts, C. Dooms, D. Van Raemdonck, B. Anrys, J. Vansteenkiste, and The Leuven Lung Cancer Group Long-term survival of surgically staged IIIA-N2 non-small-cell lung cancer treated with surgical combined modality approach: analysis of a 7-year prospective experience Ann. Onc., November 1, 2004; 15(11): 1645 - 1653. [Abstract] [Full Text] [PDF]

				J. R. Sonett, M. Suntharalingam, M. J. Edelman, A. B. Patel, Z. Gamliel, A. Doyle, P. Hausner, and M. Krasna Pulmonary Resection After Curative Intent Radiotherapy (>59 Gy) and Concurrent Chemotherapy in Non-Small-Cell Lung Cancer Ann. Thorac. Surg., October 1, 2004; 78(4): 1200 - 1205. [Abstract] [Full Text] [PDF]

				M. K. Ferguson Optimal management when unsuspected N2 nodal disease is identified during thoracotomy for lung cancer: cost-effectiveness analysis J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1935 - 1942. [Abstract] [Full Text] [PDF]