[A comparative study between clinical response and pathologic changes to preoperative chemotherapy in non-small cell...

To study the clinical response to preoperative chemotherapy in relation to pathologic changes in non-small cell lung cancer (NSCLC).

Forty-six stage I-IIIa NSCLC patients were given 1-2 courses of preoperative chemotherapy with mitomycin C (MMC) 6 mg.M-2 on day 1, vindesine (VDS) 2.5-3 mg.M-2 on day 1, day 8 and/or day 15, and cisplatin (DDP) 90 mg.M-2 on day 1 (MVP regimen). 'The treatment was recycled every 28 days. Clinical response was assessed according to WHO criteria. Pathologic changes of the resected tumor were categorized to 3 grades. Grade I: No tumor under gross and microscopic observation. Grade II: Grossly no tumor present but residual tumor cells under microscopic observation. Grade III: Tumor reduced in size with clear margins; marked tumor cells degeneration and necrosis accompanied with fibrosis. Grade IV: Active proliferation of tumor cells with invasion. Grade I-II was considered to be chemotherapeutically effective.

(1) The clinical response rate was higher in patients who had received 2 courses than those received 1 course of treatment. More patients treated with 2 courses had their pathologic changes in Grade I-II than those treated with 1 course of chemotherapy but the response rate was not fully consistent with pathologic grading. (2) Pathologic grading significantly correlated with the extent of tumor involvement but not with the lymph node status. (3) Efficacy of chemotherapy should be evaluated jointly by the clinical response and grading of pathologic changes. (4) Chemotherapy with MVP regimen did not elicit severe toxic side effect. Nor did it lead to operative morbidity, operative mortality and a delay in postoperative recovery.

Preoperative chemotherapy with MVP regimen is effective in the treatment of NSCLC in stage I-IIIa.