Results of surgical treatment after neoadjuvant chemotherapy for stage III non-small cell lung cancer

Background The potential benefits of an approach combiningneoadjuvant chemotherapy and surgery in stage IIIAand IIIB NSCLC have to be weighed against a potentialincrease in postoperative complications. We evaluated theresults in terms of postoperative complications and survivalin patients with stage III NSCLC who underwent completesurgical treatment after neoadjuvant chemotherapy withtwo regimens: mitomycin, vinblastine, and cisplatin (MPV)versus gemcitabine and cisplatin (GC).Methods From March 1991 to September 2005, 110patients with stage III NSCLC (86 stage IIIA and 24 stageIIIB) underwent complete surgical treatment after neoadjuvantchemotherapy. Ninety-two patients were men and18 were women, with a mean age of 59 (range, 39–80)years. The neoadjuvant chemotherapy regimen was MPVin 72 patients and GC in 38.Results The overall response ([50%) to chemotherapywas 84%. Postoperative mortality and morbidity were 1.8%and 20%, respectively. Overall 5-year survival was 46%.Minor response to neoadjuvant chemotherapy (\50%) andresidual nodal N2 involvement in stage IIIA had an adverseimpact on survival (p\0.05).Conclusions Favorable long-term survival was observedafter neoadjuvant chemotherapy with MPV and GCregimens in stage IIIA and IIIB NSCLC, with relativelylow postoperative mortality and morbidity. Caution shouldbe taken when offering surgical treatment to patients withminor response to induction chemotherapy and residual N2disease in view of the significantly reduced survival.