Surgery after chemotherapy for initially unresectable stage iii non-small cell lung cancer

Abstract

BACKGROUND Stage II non-small cell lung cancer represents a heterogeneous group of diseases for which multimodal therapy is today recommended including surgery, radiotherapy and chemotherapy. PATIENTS AND METHODS The purpose of the study was to retrospectively identify factors predictive of secondary complete resection, in a series of patients with initially unresectacle, non metastatic Non Small Cell Lung Cancer (NS CLC) who were treated with pre-operative chemotherapy. Patients were randomised between 3 courses of MIP (mitomycin C 6mg/m2; ifosfamide 3g/m2; cisplatin 50mg/m2) or SuperMIP (mitomycin C 6mg/m2; ifosfamide 4.5g/m2; cisplatin 60mg/m2, carboplatine 200mg/ m2). If, after 3 courses of chemotherapy, the tumour became resectable, surgery was performed followed by mediastinal irradiation. RESULTS There were 351 ellgible patient: 176 in the MIP arm, 175 in the SuperMIP arm; 43% and 51% with stages II A and II B, respectively. After chemotherapy, surgery was performed in 54 (15%, 95% CI: 12%-20%) patients. Complete resection (R0) was obtained in 40 patients. Two independent predicting factors of complete resection were identified: N status (OR : 0.06 in disfavour of N3; 95% CI: 0.007-0.410; p=0.005) and objective response to chemotherapy (OR : 3.90 in favour of objective response; 95% CI: 1.90-7.98; p <0.001). CONCLUSIONS In initially unresectable stage II NS CLC, the absence of N3 nodal involvement or a response to chemotherapy is associated with a higher chance to achieve a complete resection.