Hyperfractionated Irradiation with 3 Cycles of Induction Chemotherapy in Stage IIIA-N2 Lung Cancer

The purpose of the present study was to improve the prognosis of patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). To achieve that goal, we performed induction chemoradiotherapy followed by surgery.

The criteria for this phase II study were ≤75-year-old patients with pathologically diagnosed stage IIIA-N2 NSCLC who had performance statuses of 0 or 1 with good organ function. Three cycles of chemotherapy with paclitaxel and carboplatin were carried out, with concurrent hyperfractionated irradiation (42 Gy). After re-evaluation, pulmonary resections were considered unless patients showed progressive disease. The primary endpoint was overall survival (OS), and the secondary endpoints were disease-free survival (DFS) and absence of toxicity.

All 22 patients enrolled in this study completed the induction chemoradiotherapy without any severe complications. In these 22 patients, the 2- and 5-year OS were 81 and 47 %, respectively. There were no therapy-related deaths. Surgery was subsequently performed in 19 patients (86 %). Pathological complete responses were seen in 6 patients (27 %), while node downstaging was obtained in 10 patients (45 %). In the 19 patients who underwent surgery, the 2- and 5-year OS rates were 83 and 62 %, respectively, and the 2-year DFS rate was 63 %. All 6 patients with pathological complete responses survived without disease. Patients with residual multiple-station N2 showed worse OS and DFS rates than did those with downstaged and single-station N2 (P = 0.026 and P < 0.0001, respectively).

This trimodal therapy was effective and well tolerated, and it is an acceptable therapeutic option for patients with locally advanced stage IIIA-N2 NSCLC. Patients without persistent multiple-station N2 showed promising survival.