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.

Détails

ID Serval
serval:BIB_6B0C92A725F3
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
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.
Périodique
Journal of Clinical Oncology
Auteur(s)
Betticher D.C., Hsu Schmitz S.F., Tötsch M., Hansen E., Joss C., von Briel C., Schmid R.A., Pless M., Habicht J., Roth A.D., Spiliopoulos A., Stahel R., Weder W., Stupp R., Egli F., Furrer M., Honegger H., Wernli M., Cerny T., Ris H.B.
ISSN
0732-183X
Statut éditorial
Publié
Date de publication
2003
Peer-reviewed
Oui
Volume
21
Numéro
9
Pages
1752-1759
Langue
anglais
Résumé
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.
Mots-clé
Adult, Aged, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Carcinoma, Non-Small-Cell Lung/drug therapy, Carcinoma, Non-Small-Cell Lung/pathology, Cisplatin/administration & dosage, Female, Humans, Infusions, Intravenous, Lung Neoplasms/drug therapy, Lung Neoplasms/pathology, Lymphatic Metastasis/pathology, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Paclitaxel/administration & dosage, Paclitaxel/analogs & derivatives, Prognosis, Survival, Taxoids, Treatment Outcome
Pubmed
Web of science
Création de la notice
29/01/2008 12:59
Dernière modification de la notice
20/08/2019 14:25
Données d'usage