Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Early Result of Surgical Resection after Pre-Operative Concurrent chemoradiotherapy for N2-Positive Stage IIIA NSCLC

N2 종격동 림프절 전이가 있는 제 III A 병기 비소세포폐암에 있어 수술전 동시화학방사선요법 후 폐적출술의 조기 성적

  • 차대원 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김진국 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 심영목 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김관민 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 박근칠 (성균관대하교 의과대학 삼성서울병원 혈액종양내과) ;
  • 안용찬 (성균관대학교 의과대학 삼성서울병원 치료방사선과)
  • Published : 2000.08.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. Material and Method: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs(43∼70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy(24) and CT scans(7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. Result: All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects(6), refusal(1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. Conclusion: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.

Keywords

References

  1. Surg Clin N Am v.67 no.5 The Role of Surgery in N2 Lung Cancer Martini N;Flehinger BJ
  2. Ann Surg v.198 Results of Resection in Non-Oat Cell Carcinoma of the Lung with Mediastinal Lymph Node Metastases Martini N;Flehinger BJ;Zaman MB;Beattie EJ
  3. J Thorac Cardiovasc Surg v.83 Significance of positive superior mediastinal nodes identified at mediostinoscopy in patients with resectable cancer of the lung Pearson FG;Delaruc NC;Ilves R;Todd TRJ;Cooper JD
  4. Ann Surg v.21 no.5 Carcinoma of the Lung: Results of Treatment over Ten Years Kirsh MM;Rotman H;Argenta L(et al)
  5. Ann Surg v.20 no.5 Relationship of Cell Type and Lymph Node Metastasis to Survival After Resection of Bronchial Carcinoma Shields TW;Yee J;Conn JH;Robinette CD
  6. N Engl J Med v.326 Effects of concomitam Cisplatin and radiotherapy on inoperable non-small-cell lung cancer Schaake-Koning C;van den Bogaert W;Dalesia O(et al)
  7. Int J Radiat Oncol Biol Phys v.38 Randomized study of chemotherapy/radiation therapy combinations for Favorable patients with locally advanced inoperable nonsmall cell lung cancer: Radiation Therapy Oncology Group(RTOG) 92-04 Komaki R;Scott C;Ettinger D(et al)
  8. N Engl J Med v.323 A randomized trial of Induction chemotherapy plus high-dose radiation versus radiation alone in stage Ⅲ non-small-cell lung cancer Dillman RO;Seagren SL;Proper KJ(et al)
  9. J Clin Oncol v.13 Concurrent Cisplatin/Etoposide Plus Chest Radiotherapy Followed by Surgery for Stages IIIA (N2) and IIIB Non-Small-Cell Lung Cancer: Mature Results of Southwest Oncology Group Phase Ⅱ Study 8805 Albain KS;Rusch VW;Crowley JJ(et al)
  10. Am J Oncol v.22 no.3 Mature Results From a Phase Ⅱ Trial of Accelerated Induction Chemoradiotherapy and Surgery for Poor Prognosis Stage Ⅲ Non-Small-Cell Lung Cancer Adelstein David J;Rice Thomas W;Rybicki Lisa A(et al)
  11. Eur J Cancer v.32A Pre-operative Chemoradiotherapy in Non-small Cell Lung Cancer Stage Ⅲ Patients;Feasibility, Toxicity and Long-term Results of a Phase Ⅱ Study Favaretto;Paccagnella A;Tomio L(et al)
  12. J Thorac Cardiovasc Surg v.111 Assessment of Preoperative Accelerated Radiotherapy and Chemotherapy in Stage IIIA (N2) Non-Small-Cell Lung Cancer Mathisen DJ;Wain JC;Wright C(et al)
  13. Int J Radiant Oncol Biol Phys v.20 Astro Plenary: Effect fo Chemotherapy on Locally Advanced Non-Small-Cell Long Carcinoma: A Randomized Study of 353 Patients Arriagade R;Lc Chevalier T;Quoix E(et al)
  14. Int J Radiat Oucol Biol Phys v.5 Exploitable mechanism incombined radiotherapy-chemotherapy;The concepts of additivity Steel GG;Peckham MJ
  15. J Natl Cancer Inst v.83 Preoperative chemotherapy (cisplatin and fluorouracil) and raditation therapy in stage III non-small-cell lung cancer;a phase II study of the Lung Cancer Study Group Wejden PL;Piantodosi S
  16. J Clin Oncol v.10 Neoadjuvant chemotherapy and Radiotherapy followed by surgery in stage IIIA non-small-cell carcinoma of the Lung report of a Cancer and Leukemia Group B Phase II study Strauss GM;Herndon JE;Sherman DD(et al)
  17. J Clin Oncol v.15 Potential Impact on Survival of Improved Tumor Downstaging and Resection Rate by Preoperative Twice-Daily Radiation and Concurrent Chemotherapy in Stage IIIA Non-Small-Cell Lung Cancer Choi NC;Carey RW;DAly W(et al)
  18. Semin Radiat Oncol v.9 no.2 Phase I/IIa Study of Concurrent Pachtavel and Cisplatin With Radiation Therapy in Locally Advanced Non-Small Cell Lung Cancer: Analysis of Early and Late Pulmonary Morbidity Robert F;Childs HA;Spencer SA(et al)
  19. 대흉외지 v.32 제 IIIA기 비소세포 폐암의 수술 성적 정경영;홍기표;김창수;김길동;김주항;신동환
  20. 대한방사선종양학회지 v.17 no.2 N2병기 비소세포 폐암의 수술 전 동시화학방사선요법 이규찬;안용찬;박근칠;김관민;김진국;신영목(등)
  21. Lung Cancer v.7 Sequential chemotherapy and radiotherapy for initial management of Stage IIIA and Stage IIIB non-small-cell lung cancer.Induction chemotherapy Green MR
  22. Semin Oncol v.17 no.SUP.7 New directions in non-small-cell lung cancer Gralla RJ
  23. Semin Oncol v.17 no.SUP.7 Chemotherapy for unresectable non-small cell lung cancer Johnson DH
  24. Semin Oncol v.13 Brief overview of combination chemotherapy in non-small cell lung Cancer Bonomi P
  25. J Clin Oncol v.6 Chemotherapy can prolong survival in Patients with advanced non-small cell lung cancer: Report of a Canadian Multi-center randomized trial Rapp E;Pater IL;William A(et al)