Induction chemotherapy before lung cancer resection: Experiences and perspectives

Abstract

7329 Background: Surgical therapy can be offered only to approximately 10% of patients suffering from this disease in Czech Republic. Currently, attention is focused on treatment procedures aiming to cause a downstaging of lung cancer. We report on our experience with induction preoperative treatment of those patients in years from 1986 to 2003. Methods: The subjects of our analysis are all the patients, who were treated by preoperative oncological treatment, by chemotherapy or chemoradiotherapy followed by surgery. Also patients who underwent non-radical surgery are included. The first group (A) includes the patients, who were treated in the years from 1986 to 1999 by combinations of cytostatic agents of 1st and 2nd generations. Group B includes patients treated by combination of vinorelbine-iphosphamide-cisplatin, group C treated by combination of gemcitabine-cisplatin and group D s treated by combination of paclitaxel-carboplatin. Group E includes patients with small cell cancers. Each group was further analysed by sex, age, stage and type of tumour, extent of surgery, presence of perioperative morbidity and mortality, teatment effect on downstaging and overall survival. Number of chemotherapy cycles and possible consequential treatment administered because of residual disease or cancer relapse were also registered. Results: In groups A-D, most frequent cancer type was epidermoid, most frequent stages were IIIA/IIIB. Downstaging was found in group A in 43% of patients, in B in 46%, in C in 41%, in D in 62%. Pathologic CR was found in A in 17%, in B in 19%, in C in 25%, in D in 0%. Postoperative mortality in groups A – E was 5,3% of patients. Brain metastases in postoperative follow up were found in groups A and B in 10 patients, while in groups |C and D in none. 3-years survival was in A in 54%, in B in 40%, in C in 33%, in D in 37% and in E in 34% of patients. Out of a total of 13 patients with histological complete remission, currently 10 patients are alive; mean follow-up time being of 31 months, range 6.2 – 96.6 months. Three year survival rate is 46%, five year survival rate is 38% so far. Conclusions: Preoperative chemotherapy is of value in responders. It shares 20% in our resected patients. No significant financial relationships to disclose.