Lessons to learn from EORTC study 08981: A feasibility study of induction chemoradiotherapy followed by surgical resection for stage IIIB non-small cell lung cancer

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 55; no. 1; pp. 95 - 99
• Main Authors: Surmont, V, van Klaveren, R.J, Goor, C, Schramel, F, Manegold, C, Legrand, C, Van Schil, P, Van Meerbeeck, J.P
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.01.2007
• Subjects: Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Non-Small-Cell Lung - surgery; Chemoradiotherapy; Clinical Trials, Phase III as Topic; Combined modality; Combined Modality Therapy; Fluorodeoxyglucose F18; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Lung Neoplasms - surgery; Neoplasm Staging; Non-small cell lung cancer; PET scan; Positron-Emission Tomography; Pulmonary/Respiratory; Radiopharmaceuticals; Re-mediastinoscopy; Treatment Outcome; Re-mediastinoscopy; Combined modality; PET scan; Chemoradiotherapy; Non-small cell lung cancer
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2006.09.015

Summary The present EORTC phase II feasibility study in stage IIIB (T4-N3) NSCLC was conducted to investigate whether an induction regimen with concurrent chemoradiotherapy followed by surgery after restaging by re-mediastinoscopy and/or fluorodeoxyglucose-positron emisson tomography (FDG-PET) was feasible in a multicenter setting. Unfortunately, the study closed prematurely because of poor accrual. The combination of more stringent selection criteria, the incorrect prevailing view of Ethical Boards that a tri-modality approach is too toxic, competing studies in the participating centers and the fact that patients with N3 disease could only be enrolled if a re-mediastinoscopy could be performed, underlie the low accrual. Although this study illustrates that the conduct of a tri-modality study across Europe appeared to be difficult at that time, the number of centers with highly qualified and experienced specialists involved in this kind of multi-modality approaches is rapidly increasing. Future initiatives should, therefore, certainly be encouraged. Minimally invasive procedures such as EUS and EBUS should preferably be used for up-front mediastinal staging, mediastinoscopy with or without EUS should preferably be reserved for restaging, and especially right-sided pneumonectomies should be avoided. Though evident, the feasibility to complete this kind of studies within a reasonable time period is still a condition sine qua non.