Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas: Long-term results of Southwest Oncology Group trial 9416 (Intergroup trial 0160)

Valerie W. Rusch, Dorothy J. Giroux, Michael J. Kraut, John Crowley, Mark Hazuka, Timothy Winton, David H. Johnson, Lawrence Shulman, Frances Shepherd, Claude Deschamps, Robert B Livingston, David Gandara

Research output: Contribution to journalArticle

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Abstract

Purpose: Traditional treatment for superior sulcus non-small-cell lung cancers (SS NSCLC), radiation plus surgery, yields a 50% rate of complete resection and a 30% 5-year survival. On the basis of improved outcomes in other subsets of stage III NSCLC, this trial tested the feasibility of induction chemoradiotherapy for SS NSCLC. Patients and Methods: Patients with T3-4, N0-1 SS NSCLC received two cycles of cisplatin and etoposide concurrently with radiation (45 Gy). Patients with stable or responding disease underwent thoracotomy. All patients received two more cycles of chemotherapy. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed by Cox regression analysis. Results: From April 1995 to November 1999, 110 eligible patients (76 men, 34 women) were entered onto the study (78 T3, 32 T4 tumors). Induction therapy was completed by 104 (95%) patients. Of 95 patients eligible for surgery, 88 (80%) underwent thoracotomy, two (1.8%) died postoperatively, and 83 (76%) had complete resection. Pathologic complete response (CR) or minimal microscopic disease was seen in 61 (56%) resection specimens. Five-year survival was 44% for all patients and 54% after complete resection, with no difference between T3 and T4 tumors. Pathologic CR led to better survival than when any residual disease was present (P = .02). Disease progression occurred mainly in distant sites. Conclusion: This combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.

Original languageEnglish (US)
Pages (from-to)313-318
Number of pages6
JournalJournal of Clinical Oncology
Volume25
Issue number3
DOIs
StatePublished - Jan 20 2007
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Survival
Thoracotomy
Radiation
Radiation Dosage
Neoplasms
Chemoradiotherapy
Etoposide
Cisplatin
Disease Progression
Regression Analysis
Drug Therapy
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas : Long-term results of Southwest Oncology Group trial 9416 (Intergroup trial 0160). / Rusch, Valerie W.; Giroux, Dorothy J.; Kraut, Michael J.; Crowley, John; Hazuka, Mark; Winton, Timothy; Johnson, David H.; Shulman, Lawrence; Shepherd, Frances; Deschamps, Claude; Livingston, Robert B; Gandara, David.

In: Journal of Clinical Oncology, Vol. 25, No. 3, 20.01.2007, p. 313-318.

Research output: Contribution to journalArticle

Rusch, Valerie W. ; Giroux, Dorothy J. ; Kraut, Michael J. ; Crowley, John ; Hazuka, Mark ; Winton, Timothy ; Johnson, David H. ; Shulman, Lawrence ; Shepherd, Frances ; Deschamps, Claude ; Livingston, Robert B ; Gandara, David. / Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas : Long-term results of Southwest Oncology Group trial 9416 (Intergroup trial 0160). In: Journal of Clinical Oncology. 2007 ; Vol. 25, No. 3. pp. 313-318.
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abstract = "Purpose: Traditional treatment for superior sulcus non-small-cell lung cancers (SS NSCLC), radiation plus surgery, yields a 50{\%} rate of complete resection and a 30{\%} 5-year survival. On the basis of improved outcomes in other subsets of stage III NSCLC, this trial tested the feasibility of induction chemoradiotherapy for SS NSCLC. Patients and Methods: Patients with T3-4, N0-1 SS NSCLC received two cycles of cisplatin and etoposide concurrently with radiation (45 Gy). Patients with stable or responding disease underwent thoracotomy. All patients received two more cycles of chemotherapy. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed by Cox regression analysis. Results: From April 1995 to November 1999, 110 eligible patients (76 men, 34 women) were entered onto the study (78 T3, 32 T4 tumors). Induction therapy was completed by 104 (95{\%}) patients. Of 95 patients eligible for surgery, 88 (80{\%}) underwent thoracotomy, two (1.8{\%}) died postoperatively, and 83 (76{\%}) had complete resection. Pathologic complete response (CR) or minimal microscopic disease was seen in 61 (56{\%}) resection specimens. Five-year survival was 44{\%} for all patients and 54{\%} after complete resection, with no difference between T3 and T4 tumors. Pathologic CR led to better survival than when any residual disease was present (P = .02). Disease progression occurred mainly in distant sites. Conclusion: This combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.",
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T1 - Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas

T2 - Long-term results of Southwest Oncology Group trial 9416 (Intergroup trial 0160)

AU - Rusch, Valerie W.

AU - Giroux, Dorothy J.

AU - Kraut, Michael J.

AU - Crowley, John

AU - Hazuka, Mark

AU - Winton, Timothy

AU - Johnson, David H.

AU - Shulman, Lawrence

AU - Shepherd, Frances

AU - Deschamps, Claude

AU - Livingston, Robert B

AU - Gandara, David

PY - 2007/1/20

Y1 - 2007/1/20

N2 - Purpose: Traditional treatment for superior sulcus non-small-cell lung cancers (SS NSCLC), radiation plus surgery, yields a 50% rate of complete resection and a 30% 5-year survival. On the basis of improved outcomes in other subsets of stage III NSCLC, this trial tested the feasibility of induction chemoradiotherapy for SS NSCLC. Patients and Methods: Patients with T3-4, N0-1 SS NSCLC received two cycles of cisplatin and etoposide concurrently with radiation (45 Gy). Patients with stable or responding disease underwent thoracotomy. All patients received two more cycles of chemotherapy. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed by Cox regression analysis. Results: From April 1995 to November 1999, 110 eligible patients (76 men, 34 women) were entered onto the study (78 T3, 32 T4 tumors). Induction therapy was completed by 104 (95%) patients. Of 95 patients eligible for surgery, 88 (80%) underwent thoracotomy, two (1.8%) died postoperatively, and 83 (76%) had complete resection. Pathologic complete response (CR) or minimal microscopic disease was seen in 61 (56%) resection specimens. Five-year survival was 44% for all patients and 54% after complete resection, with no difference between T3 and T4 tumors. Pathologic CR led to better survival than when any residual disease was present (P = .02). Disease progression occurred mainly in distant sites. Conclusion: This combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.

AB - Purpose: Traditional treatment for superior sulcus non-small-cell lung cancers (SS NSCLC), radiation plus surgery, yields a 50% rate of complete resection and a 30% 5-year survival. On the basis of improved outcomes in other subsets of stage III NSCLC, this trial tested the feasibility of induction chemoradiotherapy for SS NSCLC. Patients and Methods: Patients with T3-4, N0-1 SS NSCLC received two cycles of cisplatin and etoposide concurrently with radiation (45 Gy). Patients with stable or responding disease underwent thoracotomy. All patients received two more cycles of chemotherapy. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed by Cox regression analysis. Results: From April 1995 to November 1999, 110 eligible patients (76 men, 34 women) were entered onto the study (78 T3, 32 T4 tumors). Induction therapy was completed by 104 (95%) patients. Of 95 patients eligible for surgery, 88 (80%) underwent thoracotomy, two (1.8%) died postoperatively, and 83 (76%) had complete resection. Pathologic complete response (CR) or minimal microscopic disease was seen in 61 (56%) resection specimens. Five-year survival was 44% for all patients and 54% after complete resection, with no difference between T3 and T4 tumors. Pathologic CR led to better survival than when any residual disease was present (P = .02). Disease progression occurred mainly in distant sites. Conclusion: This combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.

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U2 - 10.1200/JCO.2006.08.2826

DO - 10.1200/JCO.2006.08.2826

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