Long–term survival of patients after multimodal treatment of stage IIIA(N2) non–small cell lung cancer

Objective. To determine the overall and recurrence–free survival rates of patients with stage IIIA(N2) non–small cell lung cancer after various multimodal treatment regimens. Materials and methods. A comparative study of different modes of neoadjuvant and adjuvant treatment using radiation therapy and chemotherapy in cases of surgical intervention for stage III A (N2) non–small cell lung cancer was conducted. The effect of neoadjuvant chemoradiotherapy was studied in 43 patients, neoadjuvant chemotherapy in 200 patients, and neoadjuvant chemotherapy followed by surgery and adjuvant radiotherapy in 63 patients. In all patients, neoadjuvant chemotherapy included 4 cycles of cisplatin + docetaxel or carboplatin + paclitaxel. Radiotherapy consisted of daily sessions with a single focal dose of 2 Gy and a total focal dose of up to 50 Gy, followed by radical surgery. The study was conducted at the Department of Lung and Mediastinal Tumors of the National Cancer Institute. Results. From 12 months to the end of the study, the best recurrence–free survival rates were recorded in patients who underwent neoadjuvant chemoradiotherapy. In cases of complete and high morphological response of the tumor to treatment, they lived significantly longer than other patients in this group. Patients with complete morphological response of the tumor to treatment were also the most numerous in this group. Neoadjuvant chemoradiotherapy contributed to a reduction in the number of pneumonectomies in favor of lung resections. The overall five–year survival rate was (30.1± 5.7)%. after neoadjuvant chemoradiotherapy, (12.3± 3.5)% after neoadjuvant chemotherapy, and (6.3± 2.2)% after neoadjuvant chemotherapy with adjuvant radiotherapy. Conclusions. In terms of long–term survival rates in patients with stage IIIA (N2) non–small cell lung cancer, neoadjuvant chemoradiotherapy is superior to other methods of neoadjuvant and adjuvant treatment. Five–year recurrence–free survival rates were demonstrated only in patients who underwent neoadjuvant chemoradiotherapy and amounted to (21.5 ± 6.4)%.