Second Department of Surgery, University of Occupational and Environmental Health, Kitakyusyu, Japan.
Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Miki, Japan.
Ann Thorac Surg. 2018 Oct;106(4):1018-1024. doi: 10.1016/j.athoracsur.2018.05.027. Epub 2018 Jun 8.
The optimal therapeutic strategy for potentially resectable clinical (c-) stage IIIA-N2 non-small cell lung cancer (NSCLC) remains controversial. This phase II multiinstitutional study (West Japan Oncology Group 5308L) was designed to evaluate the feasibility of induction chemotherapy with concurrent thoracic radiotherapy (50 Gy), followed by resection and postoperative consolidation chemotherapy, in IIIA-N2 NSCLC.
Patients with resectable c-stage IIIA-N2 were eligible, and pathologic confirmation of N2 disease was mandatory. Patients received chemotherapy consisting of weekly carboplatin plus paclitaxel with concurrent radiotherapy (50 Gy in 25 fractions). Unless disease progression was documented, patients underwent surgical resection, and thereafter received two courses of consolidation chemotherapy with carboplatin plus paclitaxel. The primary end point was the proportion of patients who achieved complete resection after induction chemoradiotherapy (R0 rate).
From December 2011 to November 2013, 40 eligible patients were enrolled. All patients completed induction chemoradiotherapy with an overall response rate of 58%, and 32 patients achieved complete resection (R0 rate, 80%) mostly with lobectomy (n = 27). Twenty patients (50%) completed the study treatment, including postoperative chemotherapy. After the median follow-up period of 38 months, the progression-free survival, overall survival, and recurrence-free survival rates at 2 years were 63%, 75%, and 62%, respectively. The 30-day and 90-day mortality were 0%.
Induction chemotherapy with concurrent radiotherapy (50 Gy), followed by resection, was a feasible and promising treatment option for resectable c-stage IIIA-N2 NSCLC.
可切除的临床（c）期 IIIA-N2 非小细胞肺癌（NSCLC）的最佳治疗策略仍存在争议。这项多机构 II 期研究（西日本肿瘤学组 5308L）旨在评估诱导化疗联合胸部放疗（50Gy），随后进行切除术和术后巩固化疗，在 IIIA-N2 NSCLC 中的可行性。
符合可切除 c 期 IIIA-N2 标准的患者有资格参加，且必须有病理证实的 N2 疾病。患者接受含每周卡铂加紫杉醇的化疗联合放疗（50Gy，25 个分次）。除非疾病进展得到证实，否则患者接受手术切除，然后接受两个疗程的含卡铂加紫杉醇的巩固化疗。主要终点是诱导放化疗后完全切除的患者比例（R0 率）。
从 2011 年 12 月至 2013 年 11 月，共入组 40 例符合条件的患者。所有患者均完成诱导放化疗，总缓解率为 58%，32 例患者达到完全切除（R0 率为 80%），主要为肺叶切除术（n=27）。20 例（50%）患者完成了研究治疗，包括术后化疗。中位随访 38 个月后，2 年时无进展生存率、总生存率和无复发生存率分别为 63%、75%和 62%。30 天和 90 天死亡率均为 0%。
诱导化疗联合放疗（50Gy），随后进行切除术，是可切除的 c 期 IIIA-N2 NSCLC 的一种可行且有前途的治疗选择。
