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Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie

24.-26.10.2013, Basel, Schweiz

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Induction Chemotherapy vs. Adjuvant Radiation in Surgical Patients with Stage III NSCLC

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  • G. Seebacher - Thoraxchirurgie, LKH Krems, Krems
  • B. Sebastian - Thorax- und Gefäßchirurgie, Klinik Löwenstein, Löwenstein
  • S. Decker - Thorax- und Gefäßchirurgie, Klinik Löwenstein, Löwenstein
  • J. R. Fischer - Onkologie, Klinik Löwenstein, Löwenstein
  • H. J. Schäfers - Thorax- und Herz-Gefäß-Chirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar
  • T. P. Graeter - Thorax- und Gefäßchirurgie, Klinik Löwenstein, Löwenstein

Deutsche Gesellschaft für Thoraxchirurgie. Österreichische Gesellschaft für Thoraxchirurgie. Schweizerische Gesellschaft für Thoraxchirurgie. Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie. Basel, Schweiz, 24.-26.10.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP32

doi: 10.3205/13dgt082, urn:nbn:de:0183-13dgt0825

Published: October 14, 2013

© 2013 Seebacher et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Induction chemotherapy remains controversial in the treatment of non-small cell lung cancer (NSCLC). Our algorithm in locally advanced (T4) NSCLC or N2 lymph node disease allows the surgeon to decide between surgery followed by radiation treatment or inductive chemotherapy, surgery if possible and radiation if necessary. The decision depends on whether primary tumor and lymph nodes appear resectable. Our results are presented.

Methods: We retrospectively evaluated patients with stage III NSCLC receiving either inductive chemotherapy, surgery and adjuvant radiation if necessary (group A) or primary resection followed by adjuvant radiation (group B). From 2006 to 2011 we enrolled 197 consecutive patients (group A: n=73; group B: n=124). In group A 61 patients (83.6%) were N2 lymph node positive compared to 121 (97.6%) in group B. In the induction group 7 patients developed progressive disease and were excluded.

Results: Thirty day mortality was 0% in group A and 0.8% in group B (n=1). Histologically tumor free margins were achieved in 55 patients in group A (75.2%) and and 79 patients in group B (64.1%, p=n.s.). Five year survival was 33.3% in group A compared to 28.4% in group B (p=n.s.).

Conclusion: Considering that patients in the inductive group were thought to be inoperable the 5 year survival is promising. Surgery should be considered as a therapeutic option in locally advanced NSCLC even if N2 level lymph nodes are involved.