Report Asco 2000 New Orleans : Lung Cancer

Non-small cell lung cancer Locally advanced stages Interesting results of a prospective SWOG trial on the multimodality treatment of sulcus superior tumors were presented (1). In many centers, sulcus superior tumors (T3 N0-1) and Pancoast tumors (T4 N0-1) are treated by preoperative low-dose radiotherapy (e.g. 30 Gy) followed by either attempted surgical resection or more radiotherapy. When complete resection is possible, a 5-year survival of about 30% can be expected. This management is based on mere retrospective evidence, going back to the original data of Paulson et al. (2), which were of poor methodology, but nonetheless repeatedly cited in reviews on this topic. The question whether the merits of combined modality treatment, which are now clear in other types of stage III NSCLC, are also applicable in this setting was studied. Mediastinoscopy-negative Pancoast tumors were treated with chemoradiation induction based on cisplatin-etoposide chemotherapy and concurrent radiation up to 45 Gy. All non-progressive cases underwent thoracotomy, followed by 2 more cycles of cisplatinetoposide. The results were very appealing: 93% of the 101 eligible patients (out of 116 starters) could complete the induction. Eighty-one patients could be operated upon. Resection was complete in 68% of the patients, and a high pathologic complete response rate was noted (57% of the resection specimens). Threeyear survival was 50%, both for the T3 and T4 tumors. Although this is a non-controlled phase II study, with potentially important selection bias, it is the only prospective evidence in this setting, certainly worth considering. Furthermore, it is clear that randomized data will be very difficult to obtain in this setting.