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Long term follow-up of neoadjuvant-adjuvant combination treatment of IIIA stage non-small-cell-lung cancer: results of neoadjuvant carboplatin/vinorelbine and carboplatin/paclitaxel regimens combined with selective adjuvant chemotherapy according to in-vitro chemoresistance test.

AbstractAIM:
A prospective study investigated survival of patients with stage IIIA non-small-cell-lung cancer (NSCLC) treated with a combination of neoadjuvant and adjuvant chemotherapy.
METHODS:
Consecutive chemo-naive patients with potentially operable stage IIIA NSCLC received carboplatin-based neoadjuvant treatment. Tumor cells harvested during surgery underwent methylthiazolyl tetrazolium blue (MTT) cytotoxic assay. After surgery, adjuvant chemotherapy was selected, where possible, according to MTT results.
RESULTS:
A total of 65 patients were evaluated (31 received carboplatin/vinorelbine, 34 carboplatin/paclitaxel). The overall response rate was 67.7 % (95% confidence interval [CI]: 56.3-79.1 %) with downstaging in 52.3 % (95% CI: 40.2-64.5 %) and no significant differences between regimens. Median follow-up was 86 months: median overall survival (OS) was 32.1 months (95% CI: 7.4-46.5), median time to progression was 25.1 months (95% CI: 15.1-34.9 months) and five-year overall survival was 35.7 % (95% CI: 23.7-47.7 %). Forty-seven patients (72.3 %) underwent surgery and 43 patients received adjuvant chemotherapy. Five-year survival after tumor resection was 49.5 % (95% CI: 34.2-64.8%), median OS was 59.0 months (95% CI: 34.2-83.1) and median disease free survival after surgery was 57.3 months (95% CI: 29.5-84.4). With MTT-directed therapy, median OS was 85.1 months (95% CI: 15.4-148.6) and the 5-year survival rate was 57.0 % (95% CI: 34.5-79.5 %); the trend for longer survival failed to reach statistical significance.
CONCLUSIONS:
A combination of carboplatin-based neoadjuvant chemotherapy, surgical resection and adjuvant chemotherapy achieved satisfactory survival rates in stage IIIA NSCLC, especially in patients with complete resection of tumor and those given MTT-directed adjuvant treatment. Our results suggest MTT testing may help optimise adjuvant chemotherapy.
AuthorsVitezslav Kolek, Ivona Grygarkova, Marian Hajduch, Jiri Klein, Karol Cwiertka, Cestmir Neoral, Katerina Langova, Vladimir Mihal
JournalBiomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia (Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub) Vol. 152 Issue 2 Pg. 259-66 (Dec 2008) ISSN: 1804-7521 [Electronic] Czech Republic
PMID19219217 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Vinblastine
  • Carboplatin
  • Paclitaxel
  • Vinorelbine
Topics
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Carboplatin (administration & dosage)
  • Carcinoma, Non-Small-Cell Lung (drug therapy, mortality, surgery)
  • Chemotherapy, Adjuvant
  • Drug Resistance, Neoplasm
  • Female
  • Humans
  • Lung Neoplasms (drug therapy, mortality, surgery)
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Paclitaxel (administration & dosage)
  • Survival Rate
  • Vinblastine (administration & dosage, analogs & derivatives)
  • Vinorelbine

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