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Induction Chemoradiation and Surgical Resection for Superior Sulcus Non–Small-Cell Lung Carcinomas: Long-Term Results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160)

Valerie W. Rusch, Dorothy J. Giroux, Michael J. Kraut, John Crowley, Mark Hazuka, Timothy Winton, David H. Johnson, Lawrence Shulman, Frances Shepherd, Claude Deschamps, Robert B. Livingston, David Gandara

From the Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Cancer Research and Biostatistics; Department of Medical Oncology, University of Washington; Fred Hutchinson Cancer Research Center, Seattle, WA; Hematology/Oncology, Providence Hospital, Southfield, MI; Department of Radiation Oncology, Memorial Hospital, Colorado Springs, CO; Department of Surgery, University of Alberta, Edmonton, Alberta; Division of Hematology/Oncology, Princess Margaret Hospital, Toronto, Canada; Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN; Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Thoracic Surgery, Mayo Clinic, Rochester, MN; and the Department of Hematology/Oncology, University of California Davis Cancer Center, Sacramento, CA

Address reprint requests to Southwest Oncology Group, 14980 Omicron Dr, San Antonio, TX 78245-3217; e-mail: bgranados{at}swog.org

PURPOSE: Traditional treatment for superior sulcus non–small-cell lung cancers (SS NSCLC), radiation plus surgery, yields a 50% rate of complete resection and a 30% 5-year survival. On the basis of improved outcomes in other subsets of stage III NSCLC, this trial tested the feasibility of induction chemoradiotherapy for SS NSCLC.

PATIENTS AND METHODS: Patients with T3-4, N0-1 SS NSCLC received two cycles of cisplatin and etoposide concurrently with radiation (45 Gy). Patients with stable or responding disease underwent thoracotomy. All patients received two more cycles of chemotherapy. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed by Cox regression analysis.

RESULTS: From April 1995 to November 1999, 110 eligible patients (76 men, 34 women) were entered onto the study (78 T3, 32 T4 tumors). Induction therapy was completed by 104 (95%) patients. Of 95 patients eligible for surgery, 88 (80%) underwent thoracotomy, two (1.8%) died postoperatively, and 83 (76%) had complete resection. Pathologic complete response (CR) or minimal microscopic disease was seen in 61 (56%) resection specimens. Five-year survival was 44% for all patients and 54% after complete resection, with no difference between T3 and T4 tumors. Pathologic CR led to better survival than when any residual disease was present (P = .02). Disease progression occurred mainly in distant sites.

CONCLUSION: This combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.

Supported in part by the following Public Health Service Cooperative Agreement grants awarded by the National Cancer Institute, Department of Health and Human Services: Grants No. CA38926, CA32102, CA37981, CA46282, CA14028, CA20319, CA46368, CA46441, CA35176, CA12644, CA46113, CA22433, CA58882, CA52772, CA49957, CA23318, CA66636, CA21115, CA25224, and CA32291.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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• Induction Chemoradiotherapy for Superior Sulcus Non–Small-Cell Lung Cancer: An Answer for Few
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  JCO 2007 25: 2146 [Full Text]

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