| Abstract: |
Purpose: Retrospective reports suggest that selected patients with non-small cell lung cancer (NSCLC) and a solitary synchronous site of M1 disease may be effectively treated by resection of all disease sites. The feasibility and potential benefit of combining surgery and chemotherapy in this setting are unclear. Therefore, we performed a prospective trial to test this therapeutic approach. Methods: Patients with solitary synchronous M1 NSCLC with or without N2 disease were to receive three cycles of mitomycin, vinblastine, cisplatin (MVP) chemotherapy, followed by resection of all disease sites, and then two cycles of VP chemotherapy. Solitary brain metastases were to be resected before chemotherapy. Results: From 10/92-2/99, 23 patients (12 men, 11 women, median age=55 years) were enrolled. Mediastinoscopy, performed in 22 patients, showed involved N2 nodes in 12. The M1 sites included brain (14 patients) adrenal (3), bone (3), spleen (1), lung (1), and colon (1). Of 12 patients who completed all three induction therapy cycles, 8 underwent R0 resections. Another 5 patients had R0 resections without completing induction therapy. Eight of the 13 patients undergoing R0 resections completed postoperative chemotherapy. The median survival was 11 months; 2 patients survived to 5 years without disease. Conclusions: (1) The number of patients with solitary M1 disease who qualified for this combined modality therapy was small; (2) MVP was poorly tolerated as induction chemotherapy in this patient population; (3) Compared to historical experience with surgery alone, overall survival does not appear to be superior with this treatment strategy. Copyright © 2002 Elsevier Science Ireland Ltd. |
