SURGICAL TREATMENT OF STAGE III LUNG CANCER: A TEN
YEAR EXPERIENCE.
E. Shaugnessy MD, PhD, K. Clarke MS, T.L. Odom-Maryon PhD, F. W. Grannis Jr. MD, City of Hope National Medical Center, Duarte, CA, USA. In 1986, we adopted a new strategy for management of NSCLC based on previous poor results with radiation and/or chemotherapy treatment of patients with N2 and T3-4 Stage IIIA-B NSCLC. Based on chest CT, a decision was made as to whether a tumor was technically resectable. Enlarged mediastinal nodes were considered evidence of unresectability only if they were "bulky" i.e. larger than 4 cm. or obliterating mediastinal fat planes. Pre-operative mediastinoscopy was performed only in left sided lung cancers, in order to rule out contralateral N3 disease. Pre-operative radiation therapy was provided only to patients with superior sulcus tumors. Preoperative chemotherapy was not routinely given. At the time of surgery, a complete, systematic mediastinal node dissection was carried out in all patients. Patients with N2 status on pathologic examination were given post-operative radiation therapy but not chemotherapy. Actuarial 5 year survival was 38.9% for patients with T1-2 N2 NSCLC and 42.7% for patients with T3 N0-1 NSCLC. There were no long term survivors with T3N2 Stage IIIA NSCLC. Conclusion: Significant numbers of carefully selected patients with Stage IIIA NSCLC can be salvaged with surgical resection including mediastinal node dissection followed by radiation therapy, without neoadjuvant chemotherapy. This approach has significant advantages over routine use of neoadjuvant chemotherapy in the treatment of Stage III NSCLC. A prospective study of post-operative chemotherapy in patients with complete resection of Stage IIIA NSCLC, including mediastinal node dissection, is needed
Frederic W. Grannis Jr. M.D If you have trouble contacting me with the address above, I may also be reached at 76516,2333@compuserve.com and at fgrannis@cris.com |