Eligible patients with stage IIIA-N2 were first treated with 3 cycles of platinum based induction chemotherapy. Patient showing stable disease or progression went off study. After stratification for the type of response, histological subtype and institution, patients showing objective or minor response were randomized between either or surgical resection or radical thoracic radiotherapy consisting of 60 Gy administered at 2 Grays per fraction once daily.
Multimodality treatment of stage III NSCLC Jan P van Meerbeeck EIS-Geneva
Are you « out » when not offering your patient concurrent chemoradiotherapy?
Is there an optimal induction regimen? Van Meerbeeck 2007 EORTC 08941 3 cycles platinum-based induction chemotherapy Overall response : 61% Surgical resection Thoracic radiotherapy 60 Gy, 2 Gy/f oid No response Off study
Little evidence for differential benefit in patient subgroups
Be cautious in the elderly (75+)
Avoid PS 2 or more and major comorbidity
GTV constraints and PFT criteria
DLCO and FEV1 > 40% predicted
Contrast enhanced chest CT
PET/(CT) with at least 1 confirmatory exam of any FDG-avid extrathoracic lesion
Proof of mediastinal involvement (EUS, EBUS, mediastinoscopy)
Compulsory contrast enhanced brain imaging
Treatment plan in stage III week staging PET/ CT Cycle 1 Cycle 2 Cycle 3 Radiotherapy Restaging and RT- planning -X 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 -X
Multimodality treatment anno 2007 *Brain met’s as first failure site in 15-30% 35+ 30+ 25+ Distant progression* 30+ 25+ 20 Local progression 10 20 30 60 Alive: median 17m 5y 3y 2y 1y % of pts, after diagnosis