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Annals of Oncology 15:389-398, 2004
© 2004 European Society for Medical Oncology

Original Paper

Neoadjuvant concurrent radiochemotherapy in locally advanced (IIIA–IIIB) non-small-cell lung cancer: long-term results according to downstaging

Received 24 March 2003; revised 1 August 2003; accepted 17 December 2003

Background:

To report the efficacy of induction treatment (IT) protocol with concurrent radiochemotherapy in locally advanced non-small-cell lung cancer (NSCLC), and to analyze downstaging as a surrogate end point.

Patients and methods:

Patients with histo- or cytologically confirmed stage IIIA or IIIB NSCLC were treated according to an IT protocol followed by surgery. Downstaging was assessed for all resected patients.

Results:

In the period between February 1992 and July 2000, 92 patients were enrolled in the study (57 IIIA, 35 IIIB). Response was observed in 63 patients; 56 patients underwent radical resection. Patients downstaged to stage 0–I (DS 0–I) showed a statistically significant improved disease-free survival (26.2 months pStage 0–I versus 11.2 months pStage II–III; P = 0.0116) and overall survival (median 32.5 months pStage 0–I versus 18.3 months pStage II–III; P = 0.025). Patients with DS 0–I had a significantly lower probability (P = 0.0353) of developing distant metastases estimated in 0.2963 odds ratio.

Conclusion:

Neoadjuvant radiochemotherapy is feasible with good pathological DS results. Pathological downstaging was confirmed to have high predictive value. Its use is suggested in the short-term evaluation of induction protocols efficacy in locally advanced NSCLC.

L. Trodella1,*, P. Granone2, S. Valente3, S. Margaritora2, G. Macis4, A. Cesario2, R. M. D’Angelillo1, V. Valentini1, G. M. Corbo3, V. Porziella2, S. Ramella1, G. Tonini5, D. Galetta2, M. Ciresa1, B. Vincenzi5 and N. Cellini1

Departments of 1 Radiation Oncology, 2 Thoracic Surgery, 3 Respiratory Physiology and 4 Radiology, Università Cattolica del S. Cuore; 5 Department of Medical Oncology, Libera Università Campus Bio-Medico, Rome, Italy

Key words: concurrent radiochemotherapy, downstaging, integrated therapies, neoadjuvant radiotherapy, non-small cell lung cancer, stage IIIA-IIIB


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