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Right arrow Lung - cancer

Ann Thorac Surg 2002;73:1541-1544
© 2002 The Society of Thoracic Surgeons

Original article: general thoracic

Induction chemoradiation compared with induction radiation for lung cancer involving the superior sulcus

Cameron D. Wright, MD*a, Matthew T. Menard, MDa, John C. Wain, MDa, Dean M. Donahue, MDa, Hermes C. Grillo, MDa, Thomas J. Lynch, MDb, Noah C. Choi, MDc, Douglas J. Mathisen, MDa

a General Thoracic Surgical Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
b Medical Oncology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
c Radiation Oncology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

Accepted for publication January 23, 2002.

* Address reprint requests to Dr Wright, Blake 1570, Massachusetts General Hospital, Boston, MA 02114 USA
e-mail: wright.cameron{at}mgh.harvard.edu

Background. The usual approach of induction radiation therapy (RT) followed by resection of superior sulcus tumors results in many incomplete resections, a high local recurrence rate, and suboptimal survival. Induction chemoradiotherapy (CT/RT) has been shown to reduce local and distant recurrences and improve survival in stage III lung cancer. We investigated the role of induction CT/RT in superior sulcus patients.

Methods. This was a single-institution, retrospective study.

Results. From 1985 to 2000, 35 consecutive patients underwent induction treatment followed by resection of a superior sulcus tumor. All patients had mediastinoscopy first to exclude N2 disease, and all were N0 at final pathologic examination. Twenty patients had induction RT (mean, 39 Gy), and 15 had induction CT/RT (mean, 51 Gy) with concurrent cisplatin-based chemotherapy. There was no treatment mortality. Complete resection was performed in 16 of 20 (80%) of the RT patients and in 14 of 15 (93%) of the CT/RT patients (p = 0.15). The pathologic response from the induction treatment was complete or near complete in 7 of 20 (35%) of the RT patients and in 13 of 15 (87%) of the CT/RT patients (p = 0.001). The median follow-up was 167 months in the RT patients and 51 months in the CT/RT patients. Two-year and 4-year survival was 49% and 49% (95% confidence interval, 26% to 71%) in the RT patients and 93% and 84% (95% confidence interval, 63% to 100%) in the CT/RT patients, respectively (p = 0.01). The local recurrence rate was 6 of 20 (30%) in the RT patients and 0 in the CT/RT patients (p = 0.02).

Conclusions. Induction CT/RT for superior sulcus tumors appears to offer improved survival compared with induction RT alone.




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