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

  • Tomoshi TsuchiyaEmail author
  • Keitaro Matsumoto
  • Takuro Miyazaki
  • Hiroyuki Yamaguchi
  • Takuya Yamazaki
  • Isao Sano
  • Junya Fukuoka
  • Yoichi Nakamura
  • Naoya Yamasaki
  • Takeshi Nagayasu
Original Article
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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.

Keywords

Induction chemoradiotherapy S-1 Relapse Downstaging Non-small cell lung cancer 

Notes

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.

Compliance with ethical standards

Conflict of interest

The authors have nothing to disclosure with regard to commercial support. The authors have no conflicts of interest.

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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  • Tomoshi Tsuchiya
    • 1
    • 7
    Email author
  • Keitaro Matsumoto
    • 1
  • Takuro Miyazaki
    • 1
  • Hiroyuki Yamaguchi
    • 2
  • Takuya Yamazaki
    • 3
  • Isao Sano
    • 4
  • Junya Fukuoka
    • 5
  • Yoichi Nakamura
    • 6
  • Naoya Yamasaki
    • 1
  • Takeshi Nagayasu
    • 1
  1. 1.Department of Surgical OncologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  2. 2.Second Department of Internal MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  3. 3.Department of RadiologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  4. 4.Department of SurgeryThe Japanese Red Cross Nagasaki Genbaku HospitalNagasakiJapan
  5. 5.Department of PathologyNagasaki University HospitalNagasakiJapan
  6. 6.Department of Internal MedicineTochigi Cancer CenterUtsunomiyaJapan
  7. 7.Clinical Oncology CenterNagasaki University HospitalNagasakiJapan

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