Twelve-year follow-up of trimodality therapy for stage IIIA non-small cell lung cancer

Non-small cell carcinoma of the lung (NSCLC) remains a formidable problem with a poor 5 year survival for stage III patients. Between 1985-1991, 53 patients with biopsy proven Stage IIIA NSCLC were treated with a trimodality treatment program. Chemotherapy, consisting of two cycles of continuous infusion cisplatinum and bolus etoposide, was started on days 1 and 28 of radiation therapy (54 Gy + 5.4 Gy boost in 6 1/2 weeks) directed to the lung primary and mediastinum. Four to six weeks after radiation therapy, patients underwent thoracotomy for radical pulmonary resection. Three weeks post surgery, the same chemotherapy was repeated for two cycles every 28 days. Forty-seven out of 53 patients (89%) achieved a clinical response after induction chemoradiation. Of these 47 patients, 33 underwent thoracotomy and 27 of them completed surgical resection. Treatment was well-tolerated. All surviving patients have no or minimal respiratory toxicities. With a median follow up of 9 1/2 years, surgically treated patients have a disease specific survival of 42% at 12 years. One patient survived beyond 9 years without surgery. Concurrent chemoradiation plus surgery is well tolerated and offers patients with Stage IIIA NSCLC significant long term survival benefit and warrants further assessment in a randomized trial.