Two commonly used neoadjuvant chemoradiotherapy regimens for locally advanced XXXX : long-term results and associations with pathologic response.

@entity1 @entity137 @entity3003 @entity1149 @entity2 @entity900 @entity1311 @entity2879 @entity204
BACKGROUND: We performed this study to determine the outcomes (pathologic response, survival, local-regional control, and @entity137 ) in @entity1 treated with neoadjuvant chemoradiotherapy and planned operation for stage IIIA @entity1149 . METHODS: @entity1 treated from 1993 to 2000 with neoadjuvant chemoradiotherapy and a predetermined plan for subsequent surgical resection for @entity1149 were analyzed. All @entity1 underwent pretreatment evaluation at the university's @entity2 Center. Most @entity1 (87%) had complete mediastinoscopy staging, and all were believed to be poor candidates for up-front operation because of bulky extent of disease. The radiotherapy program used conventional, 2-dimensionally planned treatment to 45 to 54 Gy in 1.8- to 2-Gy fraction size. Concurrent chemotherapy consisted of @entity2879 / @entity900 or @entity3003 / @entity1311 . Study end points included resectability, pathologic response, local-regional control, survival, and @entity137 . An exploratory comparison between pathologic response and long-term survival was performed. An exploratory comparison between older chemotherapy ( @entity2879 / @entity900 ) and third-generation chemotherapy ( @entity3003 / @entity1311 ) was also performed. RESULTS: Of 53 @entity1 , 45 (85%) were deemed surgical candidates after induction therapy. Twenty-two (42% of the initial cohort) @entity1 had a major pathologic response to stage 0, I, or II disease. The 5-year actuarial survival was 31%. Major pathologic response was associated with improved survival (48% vs 24%; P =.027). The overall rate of early @entity204 potentially related to therapy in this series was 9%; this mostly occurred in @entity1 who underwent right pneumonectomy. There was no difference in efficacy or mortality between @entity2879 / @entity900 and radiotherapy versus @entity3003 / @entity1311 and radiotherapy, although the latter regimen was associated with less grade 3 or higher acute @entity137 necessitating interruption or hospitalization during neoadjuvant treatment (P =.02). In-field local control was achieved in 83% of all @entity1 (90% of the @entity1 who underwent resection). Brain metastases as the first site of treatment failure occurred in 23% of all @entity1 . CONCLUSIONS: Neoadjuvant concurrent chemoradiation delivers high resectability, major pathologic response rate, and excellent local-regional control, with encouraging long-term survival considering the @entity1 population studied. Major pathologic response correlates with long-term survival. Neoadjuvant @entity3003 / @entity1311 and radiotherapy is an appropriate framework on which to add new therapies.
