TY - JOUR
T1 - Trimodality therapy for superior sulcus non-small cell lung cancer
T2 - Southwest oncology group-intergroup trial s0220
AU - Kernstine, Kemp H.
AU - Moon, James
AU - Kraut, Michael J.
AU - Pisters, Katherine M.W.
AU - Sonett, Joshua R.
AU - Rusch, Valerie W.
AU - Thomas, Charles R.
AU - Waddell, Thomas K.
AU - Jett, James R.
AU - Lyss, Alan P.
AU - Keller, Steven M.
AU - Gandara, David R.
N1 - Funding Information:
This investigation was supported in part by the following Public Health Service Cooperative Agreement grant numbers awarded by the National Cancer Institute, U.S. Department of Health and Human Services : CA32102 , CA38926 , CA63848 , CA76429 , CA67575 , CA20319 , CA95860 , CA46368 , CA45377 , CA35178 , CA35176 , CA46282 , CA45808 , CA42777 , CA35431 , CA86780 , CA31946 , CA14958 , CA21115 , and CA25224 , and in part Sanofi-Aventis. The funding agencies had no involvement in the study design, data collection, analysis and interpretation, in the writing of the report, or in its submission.
PY - 2014/8
Y1 - 2014/8
N2 - Background Although preoperative chemotherapy (cisplatin-etoposide) and radiotherapy, followed by surgical resection, is considered a standard of care for superior sulcus cancers, treatment is rigorous and relapse limits long-term survival. The Southwest Oncology Group-Intergroup Trial S0220 was designed to incorporate an active systemic agent, docetaxel, as consolidation therapy. Methods Patients with histologically proven and radiologically defined T3 to 4, N0 to 1, M0 superior sulcus non-small cell lung cancer underwent induction therapy with cisplatin-etoposide, concurrently with thoracic radiotherapy at 45 Gy. Nonprogressing patients underwent surgical resection within 7 weeks. Consolidation consisted of docetaxel every 3 weeks for 3 doses. The accrual goal was 45 eligible patients. The primary objective was feasibility. Results Of 46 patients registered, 44 were eligible and assessable; 38 (86%) completed induction, 29 (66%) underwent surgical resection, and 20 (45% of eligible, 69% surgical, and 91% of those initiating consolidation therapy) completed consolidation docetaxel; 28 of 29 (97%) underwent a complete (R0) resection; 2 (7%) died of adult respiratory distress syndrome. In resected patients, 21 of 29 (72%) had a pathologic complete or nearly complete response. The known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, with 7 in the brain only. The 3-year progression-free survival was 56%, and 3-year overall survival was 61%. Conclusions Although trimodality therapy provides excellent R0 and local control, only 66% of patients underwent surgical resection and only 45% completed the treatment regimen. Even in this subset, distant recurrence continues to be a major problem, particularly brain-only relapse. Future strategies to improve treatment outcomes in this patient population must increase the effectiveness of systemic therapy and reduce the incidence of brain-only metastases.
AB - Background Although preoperative chemotherapy (cisplatin-etoposide) and radiotherapy, followed by surgical resection, is considered a standard of care for superior sulcus cancers, treatment is rigorous and relapse limits long-term survival. The Southwest Oncology Group-Intergroup Trial S0220 was designed to incorporate an active systemic agent, docetaxel, as consolidation therapy. Methods Patients with histologically proven and radiologically defined T3 to 4, N0 to 1, M0 superior sulcus non-small cell lung cancer underwent induction therapy with cisplatin-etoposide, concurrently with thoracic radiotherapy at 45 Gy. Nonprogressing patients underwent surgical resection within 7 weeks. Consolidation consisted of docetaxel every 3 weeks for 3 doses. The accrual goal was 45 eligible patients. The primary objective was feasibility. Results Of 46 patients registered, 44 were eligible and assessable; 38 (86%) completed induction, 29 (66%) underwent surgical resection, and 20 (45% of eligible, 69% surgical, and 91% of those initiating consolidation therapy) completed consolidation docetaxel; 28 of 29 (97%) underwent a complete (R0) resection; 2 (7%) died of adult respiratory distress syndrome. In resected patients, 21 of 29 (72%) had a pathologic complete or nearly complete response. The known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, with 7 in the brain only. The 3-year progression-free survival was 56%, and 3-year overall survival was 61%. Conclusions Although trimodality therapy provides excellent R0 and local control, only 66% of patients underwent surgical resection and only 45% completed the treatment regimen. Even in this subset, distant recurrence continues to be a major problem, particularly brain-only relapse. Future strategies to improve treatment outcomes in this patient population must increase the effectiveness of systemic therapy and reduce the incidence of brain-only metastases.
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U2 - 10.1016/j.athoracsur.2014.04.129
DO - 10.1016/j.athoracsur.2014.04.129
M3 - Article
C2 - 24980603
AN - SCOPUS:84905584794
SN - 0003-4975
VL - 98
SP - 402
EP - 410
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -
