IS THE COMBINATION OF NEOADJUVANT AND ADJUVANT CHEMOTHERAPY IN MARGINALLY RESECTABLE IIIA NON SMALL CELL LUNG CANCER (NSCLC) FEASIBLE?

A prospective study evaluates the combination of neoadjuvant and adjuvant chemotherapy in marginally resectable NSCLC stage IIIA. Two regimens (3 cycles) of neoadjuvant therapy were applied in 65 patients (pts), 11 women and 54 men, mean age 59 years. Paclitaxel (200 mg/m2 D1) and carboplatin (AUC 6 D1) was applied in 34 pts, vinorelbin (30 mg/m2 D1+8) with carboplatin (AUC 6 D1) in 31 pts. Surgical resection was performed in cases with objective response, radiotherapy in cases with progression. Tumor cells were harvested during surgery and tested with MTT (methylthiasol tetrazolium blue test), which indicates in-vitro chemoresistence. Selective adjuvant chemotherapy was applied sequentionally (3 cycles of two cytostatics). In-vitro effective drugs were chosen, when MTT results were obtained. Effectiveness and tolerability of the treatment schema and survival of pts were evaluated. Out of 191 neoadjuvant chemotherapy cycles, onyl 15 were postponed and 3 reduced. Toxicity gr.4 (neutropeniy mainly) did not exceed 5%. Downstaging was achieved in 34 pts (52.5%), diminishing of tumor in 15 pts (23.1%), complete resection could be realized in 47 pts (72.3%). Out of 139 adjuvant chemotherapy cycles 39 were postponed and 2 reduced. Toxicity Gr. 4 (anorexhia, neutropenia) reached 6.5%. 42 pts finished all the postponed therapeutic scheme. Median survival (ms) of opeated pts was 44.6 months, 3-years survival rate was 64.2% and 5-years survival rate 42.8%. Median of survival of inoperable pts was 14.2 months. There were no significant differences in ms between both neoadjuvant regimens (44m vs 43m). 5-year survival rate was slightly higher in pts with chemosensitive tumors according to MTT (53.8%) than in pts with resistant tumors ot tumors without known in-vitro chemoresistance (38.8%). Presented therapeutic approach is considered as feasible, highly effective and well tolerated of NSCLC.