Management of regionally advanced (stage III) non-small cell lung cancer. LCSG 831

Patients with regionally extensive non-small cell lung cancer (predominantly by virtue of metastases to mediastinal lymph nodes, less commonly by direct extension into the mediastinum) were treated predominantly with chest radiation therapy alone until the early 1980s. At that time, because of the high local recurrence rate, the higher likelihood of distant metastases, and the poor 5-year survival rates, studies were begun in these patients attempting to substitute a different local treatment modality (surgery) or to use both radiation therapy and surgery to decrease local recurrence rates and to add chemotherapy as a systemic therapy to decrease distant metastases. LCSG 831 explored the use of CAP (cyclophosphamide, doxorubicin, cisplatin) chemotherapy plus radiation therapy as preoperative or neoadjuvant therapy. Thirty-nine patients entered this phase 2 trial with 33 undergoing resection. Median survival was 11 months, and 1-year survival was 43%. These results are compared with the results of other similar trials. Explanations for the poor and differing results are suggested as are possible ways to improve study design and results.