TITLE:
Significance of Multimodality Therapy in Patients with a Superior Sulcus Tumor of the Lung: A Review Article
AUTHORS:
Gouji Toyokawa, Mitsuhiro Takenoyama, Yukito Ichinose
KEYWORDS:
Locally Advanced Non-Small Cell Lung Cancer; Superior Sulcus Tumor; Multimodality Therapy
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.5 No.1,
January
17,
2014
ABSTRACT: Despite the aggressive pursuit of diagnostic and
treatment modalities for lung cancer, the treatment outcomes are still not
satisfactory, and even patients with surgically resectable non-small cell lung
cancer (NSCLC) are often at considerable risk of suffering recurrence and/or
death from lung cancer. Regarding the treatment of patients with locally
advanced, resectable NSCLC, several retrospective and prospective studies have
shown the significance of multimodality treatments with preoperative chemoradiotherapy
and surgical treatment. However, no definitive treatment strategies for locally
advanced NSCLC patients have yet been established. One of the reasons for the
lack of established treatment strategies for patients with locally advanced
NSCLC is considered to be the heterogeneity of the population, i.e., cT4N0, cT3-4N1 and cT1a-3N2 tumors
are included in stage IIIA disease, and superior sulcus tumors (SSTs) are also
included in this classification. With regard to SST, two representative
prospective phase II trials indicated the efficacy of surgical treatment
following concurrent radiation and chemotherapy. In a study conducted by the
Southwest Oncology Group, 110 patients with superior sulcus NSCLC were treated
with two cycles of cisplatin and etoposide concurrently with 45 gray (Gy) of
radiation, followed by surgical treatment and two additional cycles of
chemotherapy postoperatively. The response rate (RR) to the preoperative
chemoradiotherapy was 86%, and 83 patients (76%) were able to undergo complete
resection. A pathological complete response (CR) was observed in 61 patients
(56%), and the five-year survival of all patients and those undergoing complete
resection was 44% and 54%,
respectively. A phase II study conducted by the Japan Clinical Oncology Group
examined the safety and efficacy of preoperative concurrent chemoradiotherapy
using mitomycin, vinblastin and cisplatin followed by surgical treatment.
Seventy-six patients with SST
were enrolled in this study, and all received chemotherapy using two cycles of
MVP concurrently with 45 Gy of radiation, followed by surgery. Neoadjuvant
chemoradiotherapy resulted in a 61% RR, and pathological complete resection was
successfully achieved in 51 patients (68%). A pathological CR was observed in
12 patients (16%), and the disease-free and overall survival rates at five
years were 45% and 56%, respectively. Both studies showed the efficacy and
tolerability of the multimodality treatment for SST, thus suggesting that
multimodality treatment with preoperative chemoradiotherapy followed by surgery
may therefore be an effective treatment for resectable SST. We herein review
the results of retrospective and prospective studies while assessing the treatment
outcomes of NSCLC patients with SST.