Background:
The optimal therapeutic strategy for potentially resectable clinical (c-) stage IIIA-N2 non-small cell lung cancer (NSCLC) remains controversial. This phase II multi-institutional study (WJOG5308L) was designed to evaluate the feasibility of induction chemotherapy with concurrent thoracic radiotherapy (50 Gy) followed by surgery and postoperative consolidation chemotherapy in IIIA-N2 NSCLC.
Methods:
Patients with resectable c-stage IIIA-N2 were eligible, and pathological confirmation of N2 disease was mandatory. Patients received chemotherapy consisting of weekly carboplatin plus paclitaxel with concurrent radiotherapy (50 Gy in 25 fractions). Unless disease progression, patients underwent surgical resection, and thereafter received two courses of consolidation chemotherapy with carboplatin plus paclitaxel. The primary endpoint was the proportion of patients who achieved complete resection after induction chemo-radiotherapy (R0 rate).
Results:
From December 2011 to November 2013, 40 eligible patients were enrolled. All patients completed induction chemo-radiotherapy with an overall response rate of 58%, and 32 patients achieved complete resection (R0 rate, 80%) mostly with lobectomy (N =27). Twenty patients (50%) completed the study treatment including postoperative chemotherapy. After the median follow-up period of 38 months, the progression-free survival, overall survival and recurrence-free survival rates at 2 years were 63 %, 75 %, and 62%, respectively. The 30-day and 90-day mortality were 0%.
Conclusions:
Induction chemotherapy with concurrent radiotherapy (50 Gy) followed by surgery was a feasible and promising treatment option for resectable c-stage IIIA-N2 NSCLC.