Trimodal regimen for superior sulcus cancer

Abstract

A multimodal regimen is safe and eff ective for the treatment of superior sulcus non-small-cell lung cancer (NSCLC; J Clin Oncol 2008; 26: 644–49). 76 patients with superior sulcus nonsmall-cell lung cancer were enrolled in a Japanese study and treated with two cycles of chemotherapy (mitomycin 8 mg/m2 on day 1, vindesine 3 mg/m2 on days 1 and 8, and cisplatin 80 mg/m2 on day 1) every 4 weeks. Radiotherapy directed at the tumour and the ipsilateral supraclavicular nodes was started on day 2 of each cycle, with a total dose given of 45 Gy in 25 fractions. Thoracotomy was done 2–4 weeks after completion of chemoradiotherapy. Those patients with unresectable disease received booster radiotherapy. 57 patients had surgical resection, and complete resection was achieved in 51 patients. 12 patients had a pathological complete response. Major postoperative respiratory disease was noted in eight patients, and there were two deaths from post-surgical complications and one from sepsis during chemoradiotherapy. 3-year disease-free and overall survival were 49% and 61%, and at 5 years were 45% and 56%, respectively. Lead author Hideo Kunitoh (National Cancer Center Hospital, Tokyo, Japan) says, “our results have confi rmed those of a prior study, and have established the trimodality approach as the standard of care for patients with superior sulcus tumour. The signifi cance of our study is the reproducibility of such an intensive approach”. “This is an important study because it addresses superior sulcus tumours, and there have been very few prospective trials with this type of lung cancer”, says James Jett (Mayo Clinic, Rochester, MN, USA). James Rigas (Norris Cotton Cancer Center, Lebanon, NH, USA) adds, “this multicentre trial confi rms the benefi ts of concurrent chemoradiation followed by surgical resection for superior sulcus NSCLC.” However, Jett added that mitomycin has potential pulmonary and other unusual toxicities, and is therefore unlikely to be employed as a standard treatment for lung cancer. Rigas agrees: “this chemotherapy regimen is very myelosuppressive, and mitomycin followed by surgical resection in the setting of thoracic radiotherapy is associated with higher rates of pulmonary disease. I think the US approach of concurrent etoposide, cisplatin, and thoracic radiotherapy followed by attempted surgical resection will remain the standard of care”.