Combined modality therapy for stage IIIA non-small cell carcinoma of the lung

Weitberg, Alan B.; Yashar, James J.; Glicksman, Arvin S.; Posner, Marshall R.; Cummings, Frank J.; Browne, Marcia; Clark, J.; Calabresi, Paul; Beitz, Julie; Murray, Connie

doi:10.1016/s0959-8049(05)80140-6

Cited by 27 publications

(10 citation statements)

References 10 publications

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“…Choi et al (6) and Weitberg et al (7) reported approximately 5% perioperative mortality rates. In our study, only one patient died after pneumonectomy.…”

Section: Discussionmentioning

confidence: 97%

Preoperative Concurrent Radiochemotherapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer

et al. 2006

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This is to examine whether aggressive multimodality therapy improves the treatment outcomes in stage IIIA non-small cell lung cancer (NSCLC). Fifty-three consecutive NSCLC patients with N2 disease, confirmed by mediastinoscopic biopsy, received preoperative thoracic radiation therapy (45 Gy/5 weeks) concurrent with two cycles of oral etoposide and intravenous cisplatin and surgery. Postoperative radiation therapy (PORT, 18 Gy/2 weeks) was optionally recommended for those with the risk factors of loco-regional recurrence based on the surgical and pathological findings. Surgical resection was performed in 38 patients (71.7%), and down-staging was achieved in 19 patients (50%). The median survival period was 27 months in 38 patients who underwent resection, and the rates at 3-yr of overall survival, loco-regional control, distant metastasis-free survival, and disease-free survival were 44.3%, 87.9%, 32.9%, and 29.3%. Significantly favorable factor regarding overall survival was achieving p0/I stage by the multivariate analysis. PORT was successful in reducing locoregional recurrences in patients with the risk factors. Current preoperative concurrent radiochemotherapy and surgery by the authors resulted in comparable survival with other reports, however, further refinement of multimodality approach may be warranted for more effective reduction of distant metastasis.

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“…Choi et al (6) and Weitberg et al (7) reported approximately 5% perioperative mortality rates. In our study, only one patient died after pneumonectomy.…”

Section: Discussionmentioning

confidence: 97%

Preoperative Concurrent Radiochemotherapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer

et al. 2006

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“…In the hope of improving the treatment results, the role of surgery to improve loco-regional control in a multimodality treatment setting was reevaluated, and the approaches of induction chemotherapy (with or without radiation therapy) and surgery have been widely investigated during the past two decades because of the encouraging results of platinumbased chemotherapy [10,11,[14][15][16][17][18]. Weitberg et al have conducted a clinical trial using induction radiation therapy plus two cycles of concurrent chemotherapy with cisplatin and etoposide, which was then followed by surgery and adjuvant chemotherapy [11].…”

Section: Discussionmentioning

confidence: 99%

“…Weitberg et al have conducted a clinical trial using induction radiation therapy plus two cycles of concurrent chemotherapy with cisplatin and etoposide, which was then followed by surgery and adjuvant chemotherapy [11]. After the induction radiochemotherapy, the clinical response rate was 89% including complete resection rate of 81% at 4-6 weeks post-induction, the median survival duration of the resected patients was 24 months, and the 2-year survival rate was approximately 50%.…”

Section: Discussionmentioning

confidence: 99%

“…The 5-year survival rates of the patients with foreseen N2 disease, which was characterized by the grossly enlarged lymph node(s) on chest CT scans (''clinical'' or ''bulky'' N2) or by mediastinoscopic biopsy (''mediastinoscopic'' N2), were in the range of 9-18% [3,5,6]. Since the efficacy of cisplatin-based chemotherapy in NSCLC has been verified, the approach of induction chemotherapy before surgery for stage III NSCLC was widely investigated, and some researchers have already reported the improvement for both in the resectability and survival [10,11]. The role of surgery in N2 positive stage IIIA NSCLC, however, has not yet been universally agreed on.…”

Section: Introductionmentioning

confidence: 99%

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Analyses on prognostic factors following tri-modality therapy for stage IIIa non-small cell lung cancer

et al. 2007

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“…Effective systemic therapy (induction chemotherapy (IC)), followed by resection with mediastinal dissection, is probably a better treatment option for these patients [46][47][48][49][50]112]. In these treatment regimes, it is well known that clearance of viable tumour cells in the mediastinum (downstaging) and pathological response in the primary tumour, are very important for prognosis [113][114][115][116][117][118]. In US data, the estimated 5-yr survival rate of patients with a pathological complete response (pCR) was 54%, while it was only 15% in those without pCR [119].…”

Section: Assessment Of Response After Induction Chemotherapymentioning

confidence: 99%

Imaging in lung cancer: positron emission tomography scan

Vansteenkiste¹

2002

European Respiratory Journal

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In the past 5 yrs, positron emission tomography (PET), usually used with 18 F-fluoro-2-deoxy-glucose (FDG), has become an important imaging modality in lung cancer patients.Currently, the use of FDG-PET in respiratory oncology is mainly for diagnosis and staging. Standard indications are the evaluation of an indeterminate solitary pulmonary nodule or mass, where FDG-PET has proven to be significantly more accurate than computed tomography (CT) in the distinction between benign and malignant lesions. Several studies have also convincingly demonstrated that locoregional lymph node staging by FDG-PET (in correlation with CT images) is significantly superior to CT, with a negative predictive value equal or even superior to mediastinoscopy. FDG-PET also improves extrathoracic staging, through the detection of lesions missed at conventional imaging or characterization of lesions that remain equivocal on conventional imaging. Many European countries now have or plan reimbursement in these indications. Large-scale randomized studies should now focus on the impact this accurate tumour imaging technique has on treatment outcome and cost-efficacy.Ongoing studies in specialized centres focus on the use of FDG-PET in more advanced clinical applications, such as planning radiotherapy, response evaluation after radiotherapy or (induction) chemotherapy, follow-up and early detection of recurrence, and prognostic information in this in vivo measurement of tumour glucose metabolism.After a short note on the technique used and a summary of the current common indications of diagnosis and staging, this paper will deal mainly with two of the more advanced clinical applications of FDG-PET in locally advanced nonsmall cell lung cancer: radiation treatment planning and assessment of induction chemotherapy.Finally, it should be mentioned that a whole new field of applications of positron emission tomography in molecular biology, using new radiopharmaceutical probes, is under extensive investigation. These techniques are promising for future use in very early response monitoring during chemo-or radiotherapy, in evaluation of novel molecular-targeted lung cancer therapies, or even gene therapy.

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Combined modality therapy for stage IIIA non-small cell carcinoma of the lung

Cited by 27 publications

References 10 publications

Preoperative Concurrent Radiochemotherapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer

Preoperative Concurrent Radiochemotherapy and Surgery for Stage IIIA Non-Small Cell Lung Cancer

Analyses on prognostic factors following tri-modality therapy for stage IIIa non-small cell lung cancer

Imaging in lung cancer: positron emission tomography scan

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