[Postoperative adjuvant therapy in combined lung cancer treatment]

The aim of the study was: to evaluate efficacy of postoperative chemotherapy and chemoradiotherapy in patients with NSCLC (N2) disease and to point out time to tumor progression and reccurence, as well as to patients survival. Study was performed as a part of International Adjuvant Lung Cancer Treatment (IALT) protocol. In 1999-2000, 110 patients patients with NSCLC with metastases to N1 and N2 regions entered the trial. Patients were randomized for investigonal group: postoperative chemotherapy 31 patients (48.4%), and chemoradiotherapy 34 patients (53.1%). These patients were compared to 45 patients who underwent only surgery (control group). Patients in the first group according to stages were: II A st. 30 patients (46.1%), IIB - 6 patients. (9.2%), IIIA st. 29 patients (44.6%). Morphology: squamos cell 44 patients (67.6%) and adeno 16 patients (24.6%).

lobectomy - 20 patients (30.7%), bilobectomy - 6 patients (9.2%), pleuropneumonectomy 13 patients (20%), combined pneumonectomy 13 patients (20%), pneumonectomy 12 patients (18.4%). Chemotherapy started within 60 days after operation. Radiation started in 10 days after last cycle of chemotherapy.

Postoperatively 42.8% patients had reccurences after pneumonectomy. In surgery group 26.6% patients had reccurences in 3-year period. Medial survival in adjuvant group was 21.3 months. In surgery group three-year survival was in 19.7% of patients, chemoradiation group - 42.4%, and chemotherapy group - 37.2%.

Postoperative adjuvant therapy remains unsolved and controversal problem. Neither chemotherapy, nor chemoradiotherapy has real impact on survival: 3-year survival in surgery group was observed in 19.7%, in chemoradiation - 42.2%, and in chemotherapy group in 37.2% of patients. Efficacy of postoperative treatment depends on radical removal of lymphodes, tumor morphology and postoperative complications.