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10-year long-term survival (LTS) of induction chemotherapy with three cycles cisplatin/paclitaxel followed by concurrent chemoradiation cisplatin/etoposide/45 Gy (1.5 Gy bid) plus surgery in locally advanced non-small-cell lung cancer (NSCLC)—A multicenter phase-II trial (CISTAXOL)
Authors:Wilfried Ernst Erich Eberhardt  Thomas Christoph Gauler  Cecile LePechoux  Georgios Stamatis  Stephan Bildat  Thomas Krbek  Stefan Welter  Dominique Grunenwald  Berthold Fischer  Hepp de los Rios Rodrigo  Dirk Theegarten  Thierry Le Chevalier  Siegfried Seeber  Martin Stuschke  Christoph Poettgen
Affiliation:1. West German Cancer Centre, Department of Medical Oncology, 45122 Essen, Germany;2. Department of Radiotherapy, Institute Gustave Roussy, Villejuif, France;3. Department of Thoracic Surgery, Ruhrlandclinic, Essen, Germany;4. Klinik für Onkologie, Hämatologie und Immunologie, Klinikum Herford, Germany;5. Department of Thoracic Surgery, Krankenhaus Bethanien, Moers, Germany;6. Department of Thoracic Surgery and Vascular Surgery, Hopital Tenon, Paris, France;g Department of Pneumology, University Hospital Mainz, Mainz, Germany;h Department of Radiation Therapy, Evangelisches Krankenhaus, Gelsenkirchen, Germany;i Department of Pathology and Neuropathology, University Hospital Essen, Germany;j Department of Medical Oncology, Institute Gustave Roussy, Villejuif, France;k Kliniken Essen-Mitte, Huyssen-Stiftung, Essen, Germany;l Department of Radiation Oncology, University Hospital Essen, Essen, Germany
Abstract:

Background

Induction chemoradiotherapy plus surgery remains an option to study in IIIA(N2) and selected IIIB NSCLC. Here we report ten-year long-term survival of a prospective multicenter German–French phase-II trial with trimodality.

Patients and methods

Mediastinoscopically proven IIIA(N2)/selected IIIB NSCLC received three cycles cisplatin (50 mg/m2 day 1 + 8) and paclitaxel (175 mg/m2 d1) qd 22. Concurrent CTx/RTx followed: 45 Gy (1.5 Gy bid) with cisplatin 50 mg/m2 day 2 + 9 and etoposide 100 mg/m2 d 4–6. Surgery was planned three to five weeks after RTx. If evaluated inoperable/irresectable at the end of RTx, definitive RTx-boost (20 Gy; 2 Gy qd) followed. Here we report 10-year-LTS for this cohort.

Results

All 64 patients were accrued 3/99 to 2/02. Patients characteristics: IIIA(N2)/IIIB 25/39; m/f 48/16; adeno/squamous/large-cell/adenosquamous/NOS 15/26/18/3/2; age: median 52.5 (range 33–69). 36 operated: R0 32/36 (89%); pCR 16/36 (44%). 10-year-LTS%; all 26.0; IIIA(N2) 37.1; IIIB 17.9; relevant prognostic factors (exploratory): pretreatment – histopathology (squamous/adeno) – age (<50/≥50) – Charlson-CI: 1/>1 – BMI (≥25/<25) – pack years smoking (≥10/<10); treatment-dependent – R0/no-R0.

Conclusions

This regimen achieves substantial LTS. Interestingly, adenocarcinomas, older patients, unfavorable comorbidity scores, higher BMI and light smokers demonstrate poor long-term outcome even with aggressive trimodality. This dataset defines the rationale for our ongoing randomized trial with surgery after induction therapy in IIIA(N2)/selected IIIB (ESPATÜ).
Keywords:Lung cancer   Trimodality treatment   Induction chemoradiotherapy   Surgery   10-Year survival   Prognostic factors
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