10-year long-term survival (LTS) of induction chemotherapy with three cycles cisplatin/paclitaxel followed by concurrent chemoradiation cisplatin/etoposide/45Gy (1.5Gy bid) plus surgery in locally advanced non-small-cell lung cancer (NSCLC)—A multicenter phase-II trial (CISTAXOL)

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 82; no. 1; pp. 83 - 89
• Main Authors: Eberhardt, Wilfried Ernst Erich, Gauler, Thomas Christoph, LePechoux, Cecile, Stamatis, Georgios, Bildat, Stephan, Krbek, Thomas, Welter, Stefan, Grunenwald, Dominique, Fischer, Berthold, Rodrigo, Hepp de los Rios, Theegarten, Dirk, Le Chevalier, Thierry, Seeber, Siegfried, Stuschke, Martin, Poettgen, Christoph
• Format: Journal Article
• Language: English
• Published: Elsevier Ireland Ltd 01.10.2013
• Subjects: 10-Year survival; Induction chemoradiotherapy; Lung cancer; Prognostic factors; Surgery; Trimodality treatment; Trimodality treatment; 10-Year survival; Lung cancer; Surgery; Induction chemoradiotherapy; Prognostic factors
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2013.06.007

Induction chemoradiotherapy plus surgery remains an option to study in IIIA(N2) and selected IIIB NSCLC. Here we report ten-year long-term survival of a prospective multicenter German–French phase-II trial with trimodality. Mediastinoscopically proven IIIA(N2)/selected IIIB NSCLC received three cycles cisplatin (50mg/m2 day 1+8) and paclitaxel (175mg/m2d1) qd 22. Concurrent CTx/RTx followed: 45Gy (1.5Gy bid) with cisplatin 50mg/m2 day 2+9 and etoposide 100mg/m2 d 4–6. Surgery was planned three to five weeks after RTx. If evaluated inoperable/irresectable at the end of RTx, definitive RTx-boost (20Gy; 2Gy qd) followed. Here we report 10-year-LTS for this cohort. All 64 patients were accrued 3/99 to 2/02. Patients characteristics: IIIA(N2)/IIIB 25/39; m/f 48/16; adeno/squamous/large-cell/adenosquamous/NOS 15/26/18/3/2; age: median 52.5 (range 33–69). 36 operated: R0 32/36 (89%); pCR 16/36 (44%). 10-year-LTS%; all 26.0; IIIA(N2) 37.1; IIIB 17.9; relevant prognostic factors (exploratory): pretreatment – histopathology (squamous/adeno) – age (<50/≥50) – Charlson-CI: 1/>1 – BMI (≥25/<25) – pack years smoking (≥10/<10); treatment-dependent – R0/no-R0. This regimen achieves substantial LTS. Interestingly, adenocarcinomas, older patients, unfavorable comorbidity scores, higher BMI and light smokers demonstrate poor long-term outcome even with aggressive trimodality. This dataset defines the rationale for our ongoing randomized trial with surgery after induction therapy in IIIA(N2)/selected IIIB (ESPATÜ).