Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Betticher, DC; Hsu Schmitz, SF; Tötsch, M; Hansen, E; Joss, C; von Briel, C; Schmid, RA; Pless, M; Habicht, J; Roth, AD; Spiliopoulos, A; Stahel, R; Weder, W; Stupp, R; Egli, F; Furrer, M; Honegger, H; Wernli, M; Cerny, T; Ris, HB.
Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small-cell lung cancer: a multicenter phase II trial.
J Clin Oncol. 2003; 21(9):1752-1759
Doi: 10.1200/JCO.2003.11.040
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- Co-Autor*innen der Med Uni Graz
- Tötsch Martin
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- Abstract:
- PURPOSE: A multicenter, phase II trial investigated the efficacy and toxicity of neoadjuvant docetaxel-cisplatin in locally advanced non-small-cell lung cancer (NSCLC) and examined prognostic factors for patients not benefiting from surgery. PATIENTS AND METHODS: Ninety patients with previously untreated, potentially operable stage IIIA (mediastinoscopically pN2) NSCLC received three cycles of docetaxel 85 mg/m2 day 1 plus cisplatin 40 mg/m2 days 1 and 2, with subsequent surgical resection. RESULTS: Administered dose-intensities were docetaxel 85 mg/m2/3 weeks (range, 53 to 96) and cisplatin 95 mg/m2/3 weeks (range, 0 to 104). The 265 cycles were well tolerated, and the overall response rate was 66% (95% confidence interval [CI], 55% to 75%). Seventy-five patients underwent tumor resection with positive resection margin and involvement of the uppermost mediastinal lymph node in 16% and 35% of patients, respectively (perioperative mortality, 3%; morbidity, 17%). Pathologic complete response occurred in 19% of patients with tumor resection. In patients with tumor resection, downstaging to N0-1 at surgery was prognostic and significantly prolonged event-free survival (EFS) and overall survival (OS; P =.0001). At median follow-up of 32 months, the median EFS and OS were 14.8 months (range, 2.4 to 53.4) and 33 months (range, 2.4 to 53.4), respectively. Local relapse occurred in 27% of patients with tumor resection, with distant metastases in 37%. Multivariate analyses identified mediastinal clearance (hazard ratio, 0.22; P =.0003) and complete resection (hazard ratio, 0.26; P =.0006) as strongly prognostic for increased survival. CONCLUSION: Neoadjuvant docetaxel-cisplatin is effective and tolerable in stage IIIA pN2 NSCLC. Resection is recommended only for patients with mediastinal downstaging after chemotherapy.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Aged -
- Antineoplastic Combined Chemotherapy Protocols - therapeutic use
- Carcinoma, Non-Small-Cell Lung - drug therapy Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - surgery
- Cisplatin - administration and dosage
- Female -
- Humans -
- Infusions, Intravenous -
- Lung Neoplasms - drug therapy Lung Neoplasms - pathology Lung Neoplasms - surgery
- Lymphatic Metastasis - pathology
- Male -
- Middle Aged -
- Neoadjuvant Therapy -
- Neoplasm Staging -
- Paclitaxel - administration and dosage Paclitaxel - analogs and derivatives
- Prognosis -
- Survival -
- Taxoids -
- Treatment Outcome -