Effects of Sequential Neoadjuvant Chemotherapy and Radiotherapy in Locally Advanced Non Small Cell Lung Cancer: Long Term Results

To evaluate the long term results of sequential neoadjuvant chemotherapy followed by radiotherapy in locally advanced non small ciell lung cancer(NSCLC), 32 patients with stage III NSCLC were studied.

Neoadjuvanjt chemotherapy was performed with 2-3 cycles of cisplatin containing combination at the interval of 3-4 weeks, and then radiotherapy to and primary tumor, mediastinum and both supaclavicular lymph nodes was followed.

The results were as follows:

1) After neoadjuvant chemotherapy, partial remission(PR) rate was 59.4% without complete remission(CR). At completion of radiotherapy, CR rate was 28.1%, PR rate 50.0% and overall response rate was 78.1%.

2) The median survival of all patients was 14.4 months, for stage III A NSCLC patients was 22 months compared to 11.4 month in stage III B NSCLC patients without significance. For responder of neoadjuvant chemotherapy, median survival was 16.6 months, and 9.3 months for the non responder(p<0,05). Median survival of responders at completion of chemotherapy was 26.8 months at the rangd of 4-48 months. Overall survival rate at 2 year was 27.1% and continued plateau till 50 months without late relapse.

3) The acute toxicities were tolerable in all patients and not fatal, but late complications of three restricitive pneumonitis and one cough induced syncopal attack compromise the quality of life among the 8 long term survivors who lived over 2 years.

4) The relapse rate was 58.1%(18 out of 31 cases) and the pattern of relapse was local in 14 cases(45.2%), systemic in 3 cases(9.7%) and local plus systemic in 1 case(3.2%). The sites of systemic relapse were brain in 3 cases and brain combined with bone in 1 case.

In conclusion, sequential neoadjuvant chemotherapy and radiotherapy can prolong the survival and diminish the systemic relapse in locally advanced non small cell lung cancer patients but local failure was the main problem in these patients.

To enhance the local control, other trials such as concurrent chemoradiotherapy, hyperfractionated radiotherapy combined with developing more effective new chemotherapeutic agents and combined regimens should be further investigated.