Combining treatments for superior sulcus NSCLC

Abstract

A combined-modality approach has been shown to improve survival in patients with superior-sulcus nonsmall-cell lung cancer (NSCLC; J Clin Oncol 2007; 25: 313–18). 110 patients (76 men and 34 women, aged 36–77 years) with superior sulcus NSCLC were treated with two cycles of cisplatin and etoposide concurrently with radiotherapy at 45 Gy. Six patients did not complete induction treatment, and a further nine were excluded because of disease progression. Of the 95 patients eligible for surgery, 88 underwent thoracotomy; two died postoperatively and 83 had complete resection. 49 patients received a further two cycles of chemotherapy, and six patients received one cycle. The median survival for all eligible patients was 33 months, and 94 months for those who had undergone complete resection. The researchers believe that local control and overall survival was substantially improved compared with previous studies of radiation and resection. Prudence Lam, Beth Israel Deaconess Medical Center, Boston, MA, USA, says: “these are encouraging results with the use of preoperative concurrent radiotherapy and cisplatin and etoposide, although it is still quite a toxic regimen. We have suggested that there is a need for early combined modality therapy. This study shows that this is benefi cial and that perhaps induction chemotherapy is not needed. I do think a multimodal approach is the most promising, although our fi rst priority must still be to decrease treatment toxicity. The most promising way to achieve this may be the use of novel, targeted, single agents in conjunction with radiation therapy”. Benedict Daly, Boston Medical Center, MA, USA, adds: “induction therapy for advanced potentially operable lung cancer has resulted in signifi cant increases in survival; however, the induction therapy in the current study uses lower radiation doses than more aggressive protocols that suggest even better results”.