Clinical treatment strategies incorporating chemotherapy and radiation therapy followed by surgical removal of Stage IIIB non small cell lung cancers have previously been demonstrated to be feasible but associated with significant side effects and mortality mainly attributable to post surgical complications. Nonetheless, patients who are good surgical candidates are currently offered multi-modality treatment with chemotherapy, radiation therapy, and surgical removal of their cancer.
A clinical trial was designed for treatment of Stage IIIB non small cell lung cancer that evaluated a strategy of Platinol® (cisplatin) and VePesid® (etoposide) chemotherapy plus radiation therapy followed by additional radiation therapy and chemotherapy instead of surgery. Fifty patients were treated with this strategy and the major side effects from treatment included neutropenia, esophagitis, and anemia; 1 patient died from complications of therapy. The 3 year survival rate for this treatment approach was 26% which is very similar to the 24% 3 year survival previously reported by the same physicians using a treatment strategy incorporating the same chemotherapy and radiation treatment followed by surgery. One subset of patients, the T4N0/1, had a 33% overall survival at 2 years which compared less favorably than the historical experience of 64% suggesting surgery following chemotherapy and radiation may be beneficial in this one group of patients.
In summary, this clinical trial strongly suggests that the majority of patients with Stage IIIB non small cell lung cancer can be spared surgery and its complications if treated with combination chemotherapy and radiation therapy. Additional clinical trials will be performed to determine whether certain subsets of patients with Stage IIIB non small cell lung cancer benefit from surgical removal of their cancer following chemotherapy and radiation therapy. (Proceedings American Society of Clinical Oncology, Vol 16, pp 446a, 1997)
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