Surgical results of maximal local-regional treatment (cisplatin-enhanced high-dose radiotherapy and adjuvant surgery) in initially non-resectable stage III lung cancer

We report the surgical short- and long-term results in 42 patients treated in a phase II trial with 50-60 Gy cisplatin-enhanced radiotherapy (RT) and adjuvant resection, for initially non-resectable stage III non-small cell lung cancer. Six of the 42 patients had a complete response, 31 a partial response and five stable disease at the presurgical clinical restaging. A complete pathologic response was observed in 19 cases (R0a surgery); 15 complete resections were performed due to persistent disease (R0b). There were eight non-radical operations (R+). Operative deaths were seen after right pneumonectomy (five cases) and in case of a non-radical operation after no response following the chemo-radiotherapy schedule (two cases). Surgery should be contraindicated in these cases. Overall eight-year-survival was 26% (37% in R0a and 27% in R0b patients). No patient with R+ surgery survived at the eighth year. A local progression as initial failure occurred in four of the 34 R0 patients, and in five of the eighth with a R+ procedure. Resection seems to improve local control, but its role needs further definition. However, advanced stage III patients treated only with a local therapy were not precluded from a long-term survival. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.