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Concurrent chemoradiotherapy using cisplatin and S-1, followed by surgery for stage II/IIIA non-small cell lung cancer

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Abstract

Objectives

Because chemoradiotherapy using cisplatin and S-1, an oral fluoropyrimidine, is effective for unresectable non-small cell lung cancer (NSCLC), an induction setting was used in a multicenter phase II study (Clinical trial number: UMIN000008205). The correlations of relapse and clinicopathological factors were analyzed.

Methods

We defined locally advanced NSCLC as pathologically proven chest wall invasion or hilar and/or mediastinal lymph node metastases by endobronchial ultrasound-guided transbronchial needle aspiration. The patients received two courses of S-1 administration for 14 days and intravenous cisplatin injection on day 8. A total dose of 40 Gy radiotherapy was concurrently received. Surgical resection was performed after completion of the treatment.

Results

Of the 23 eligible patients, 18 had stage IIIA and 5 had stage IIB NSCLC. Twenty of the eligible patients (87.0%) completed the regimen. Six (26.1%) complete responses were identified and 12 cases (52.2%) were histopathologically downstaged by induction chemoradiotherapy (ICRT). The 3-year overall survival rate was 58.1% and relapse-free survival (RFS) rate was 52.0%, respectively. Among several clinicopathological parameters, univariate RFS analysis identified that only downstaging was significantly associated with longer RFS times (p = 0.003). The radiological response did not reflect pathological response. When the variables of preoperative pathologically proven N2 metastasis, pathological ICRT effectiveness, and downstaging were included in the Cox proportional hazard modes, only the parameter of downstaging displayed significant hazard ratio (hazard ratio 0.13, p = 0.010).

Conclusion

This protocol is considered an option among preoperative therapies and has obvious benefits for pathologically downstaged cases.

Clinical trial number

UMIN000008205.

Trial registration date

June 19, 2012.

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Acknowledgements

We wish to thank Dr. Sumihisa Honda and Dr. Shuntaro Sato for providing statistical advice. We also thank Dr. Mary Durbin for critical reading of the manuscript.

Funding

No funding was provided.

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Authors and Affiliations

  1. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Tomoshi Tsuchiya, Keitaro Matsumoto, Takuro Miyazaki, Naoya Yamasaki & Takeshi Nagayasu

  2. Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Hiroyuki Yamaguchi

  3. Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Takuya Yamazaki

  4. Department of Surgery, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan

    Isao Sano

  5. Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan

    Junya Fukuoka

  6. Department of Internal Medicine, Tochigi Cancer Center, Utsunomiya, Japan

    Yoichi Nakamura

  7. Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan

    Tomoshi Tsuchiya

Authors
  1. Tomoshi Tsuchiya
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  2. Keitaro Matsumoto
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Correspondence to Tomoshi Tsuchiya.

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Tsuchiya, T., Matsumoto, K., Miyazaki, T. et al. Concurrent chemoradiotherapy using cisplatin and S-1, followed by surgery for stage II/IIIA non-small cell lung cancer. Gen Thorac Cardiovasc Surg 67, 537–543 (2019). https://doi.org/10.1007/s11748-018-01058-3

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