Postoperative Adjuvant Chemotherapy and Radiotherapy for Stage II and III Non-Small Cell Lung Cancer (NSCLC).
- Author:
Jin Hong PARK
1
;
Sang Wook LEE
;
Eun Kyung CHOI
;
Weon Kuu CHUNG
;
Kyung Hwan SHIN
;
Seung Do AHN
;
Jong Hoon KIM
;
Sang We KIM
;
Cheolwon SUH
;
Jung Shin LEE
;
Woo Sung KIM
;
Dong Soon KIM
;
Dong Kwan KIM
;
Seung Il PARK
;
Kwang Hyun SOHN
Author Information
1. Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. ekchoi@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Non-small cell lung cancer;
Surgical treatment;
Radiation treatment;
Chemotherapy
- MeSH:
Carcinoma, Non-Small-Cell Lung*;
Chemotherapy, Adjuvant*;
Cisplatin;
Classification;
Disease-Free Survival;
Drug Therapy;
Esophagitis;
Humans;
Lung Neoplasms;
Neoplasm Metastasis;
Pneumonectomy;
Prospective Studies;
Radiotherapy*;
Radiotherapy, Adjuvant;
Recurrence;
Survival Rate;
Vinblastine;
Weight Loss
- From:Journal of Lung Cancer
2002;1(1):34-40
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: The role of postoperative adjuvant chemo-radiotherapy in the treatment of patients with non-small cell lung cancer (NSCLC) remains unclear. This study was undertaken to evaluate the survival outcomes, relapse patterns, prognostic factors and complications of postoperative adjuvant MVP chemotherapy and radiotherapy. MATERIALS AND METHODS: The study involved some 96 patients who had undergone curative resection of stage II and III NSCLC between 1991 and 1996. Among these, 94 patients who completed their adjuvant treatment were analyzed. Surgery consisted of pneumonectomy (33%), single lobectomy (54%) or bilobectomy (13%). Within 4 weeks of curative resection, two cycles of MVP chemotherapy (mitomycin C 8 mg/m2, vinblastine 8 mg/m2, cisplatin 60 mg/m2) were started at 4 weeks intervals. Conventionally fractionated radiotherapy was given 3 weeks after chemotherapy to a total dose of 50 Gy in completely resected patients and 55~60 Gy in patients with positive resection margins. RESULTS: The TNM classification of the AJCC, as revised in 1997, was used for pathologic staging. The number of patients at AJCC stages IIa, IIb, IIIa, and IIIb were 4, 40, 45, and 5, respectively. A pathologically positive bronchial resection margin was found in nine patients. At the time of analysis, death was recorded in 29 patients (31%), though five had died without evidence of lung cancer. Overall 2-year, 3-year, and 5-year survival rates for all patients were 74.2%, 70.2%, and 65%, respectively, locoregional diseasefree survival (LRDFS) rates were 88.6%, 83.7%, 74.3%, at 2-years, 3-years, and 5-years, and distant metastasis disease-free survival (DMDFS) rates were 67.7%, 65.0%, and 63.6%, respectively. In the multivariate model, a primary tumor size of more than 5 cm and the level of pathologically positive nodes were found to be associated with poor overall survival, LRDFS and DMDFS. Although positive bronchial resection margin affected overall survival, LRDFS and DMDFS were unaffected. With respect to the first site of relapse, distant metastasis occurred more frequently (N=33, 35%) than locoregional recurrence (N=15, 16%). Grade 3 esophagitis in two patients and weight loss of more than 10% in five patients were observed during adjuvant treatment. Grade 4 pulmonary toxicity was observed in one patient after radiotherapy and this patient ultimately died 5 months after treatment. CONCLUSION: The postoperative adjuvant MVP chemotherapy and radiotherapy regimen showed relatively low locoregional recurrence and distant metastasis rates and good survival rate with acceptable toxicity. A prospective randomized trial, which compares this regimen to surgery alone or postoperative adjuvant radiotherapy is needed.
