Primary chemotherapy in stage IIIA non-small cell lung cancer patients with clinically apparent mediastinal lymph node metastases: focus on five-year survivors

Stage IIIA non-small cell lung cancer patients with clinically apparent ipsilateral mediastinal lymph node metastases have an 18% resectability rate and a 3-year survival of 9% for resected patients. In an effort to improve these outcomes, we have treated 73 patients with chemotherapy prior to surgical exploration. All received 2-3 cycles of cisplatin (≥ 100 mg/m²), vindesine or vinblastine, and 84% received mitomycin (MVP). Radiotherapy was not given preoperatively. Major objective responses occurred in 77%. Overall, 79% were explored and 60% were completely resected. Pathologic complete responses were documented in 12%. Two additional cycles of chemotherapy were given postoperatively to resected patients. Patients with tumor in their resected mediastinal lymph nodes received mediastinal radiotherapy. The median survival for all patients was 19 months and the 5-year survival 16%. For completely resected patients, the median survival was 27 months and the 5-year survival 25%. Of the 42 patients who entered the trial 5 or more years ago, 8 survived at least 5 years. Six remain disease free and enjoy an excellent functional status. No chronic toxicity has occurred. For relapsed patients, most recurrences are systemic. Primary MVP chemotherapy produces high response rates and improves both resectability and survival. Further trials are underway to improve primary chemotherapy regimens and to identify methods to prevent systemic recurrence.