Trimodality therapy for superior sulcus non-small cell lung cancer: Southwest oncology group-intergroup trial s0220

Kemp H. Kernstine, James Moon, Michael J. Kraut, Katherine M W Pisters, Joshua R. Sonett, Valerie W. Rusch, Charles R. Thomas, Thomas K. Waddell, James R. Jett, Alan P. Lyss, Steven M. Keller, David R Gandara

Research output: Contribution to journalArticle

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Abstract

Background Although preoperative chemotherapy (cisplatin-etoposide) and radiotherapy, followed by surgical resection, is considered a standard of care for superior sulcus cancers, treatment is rigorous and relapse limits long-term survival. The Southwest Oncology Group-Intergroup Trial S0220 was designed to incorporate an active systemic agent, docetaxel, as consolidation therapy. Methods Patients with histologically proven and radiologically defined T3 to 4, N0 to 1, M0 superior sulcus non-small cell lung cancer underwent induction therapy with cisplatin-etoposide, concurrently with thoracic radiotherapy at 45 Gy. Nonprogressing patients underwent surgical resection within 7 weeks. Consolidation consisted of docetaxel every 3 weeks for 3 doses. The accrual goal was 45 eligible patients. The primary objective was feasibility. Results Of 46 patients registered, 44 were eligible and assessable; 38 (86%) completed induction, 29 (66%) underwent surgical resection, and 20 (45% of eligible, 69% surgical, and 91% of those initiating consolidation therapy) completed consolidation docetaxel; 28 of 29 (97%) underwent a complete (R0) resection; 2 (7%) died of adult respiratory distress syndrome. In resected patients, 21 of 29 (72%) had a pathologic complete or nearly complete response. The known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, with 7 in the brain only. The 3-year progression-free survival was 56%, and 3-year overall survival was 61%. Conclusions Although trimodality therapy provides excellent R0 and local control, only 66% of patients underwent surgical resection and only 45% completed the treatment regimen. Even in this subset, distant recurrence continues to be a major problem, particularly brain-only relapse. Future strategies to improve treatment outcomes in this patient population must increase the effectiveness of systemic therapy and reduce the incidence of brain-only metastases.

Original languageEnglish (US)
Pages (from-to)402-410
Number of pages9
JournalAnnals of Thoracic Surgery
Volume98
Issue number2
DOIs
StatePublished - 2014

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Non-Small Cell Lung Carcinoma
docetaxel
Recurrence
Etoposide
Cisplatin
Therapeutics
Brain
Radiotherapy
Survival
Adult Respiratory Distress Syndrome
Standard of Care
Disease-Free Survival
Thorax
Neoplasm Metastasis
Drug Therapy
Incidence
Population
Neoplasms

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Trimodality therapy for superior sulcus non-small cell lung cancer : Southwest oncology group-intergroup trial s0220. / Kernstine, Kemp H.; Moon, James; Kraut, Michael J.; Pisters, Katherine M W; Sonett, Joshua R.; Rusch, Valerie W.; Thomas, Charles R.; Waddell, Thomas K.; Jett, James R.; Lyss, Alan P.; Keller, Steven M.; Gandara, David R.

In: Annals of Thoracic Surgery, Vol. 98, No. 2, 2014, p. 402-410.

Research output: Contribution to journalArticle

Kernstine, KH, Moon, J, Kraut, MJ, Pisters, KMW, Sonett, JR, Rusch, VW, Thomas, CR, Waddell, TK, Jett, JR, Lyss, AP, Keller, SM & Gandara, DR 2014, 'Trimodality therapy for superior sulcus non-small cell lung cancer: Southwest oncology group-intergroup trial s0220', Annals of Thoracic Surgery, vol. 98, no. 2, pp. 402-410. https://doi.org/10.1016/j.athoracsur.2014.04.129
Kernstine, Kemp H. ; Moon, James ; Kraut, Michael J. ; Pisters, Katherine M W ; Sonett, Joshua R. ; Rusch, Valerie W. ; Thomas, Charles R. ; Waddell, Thomas K. ; Jett, James R. ; Lyss, Alan P. ; Keller, Steven M. ; Gandara, David R. / Trimodality therapy for superior sulcus non-small cell lung cancer : Southwest oncology group-intergroup trial s0220. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 2. pp. 402-410.
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title = "Trimodality therapy for superior sulcus non-small cell lung cancer: Southwest oncology group-intergroup trial s0220",
abstract = "Background Although preoperative chemotherapy (cisplatin-etoposide) and radiotherapy, followed by surgical resection, is considered a standard of care for superior sulcus cancers, treatment is rigorous and relapse limits long-term survival. The Southwest Oncology Group-Intergroup Trial S0220 was designed to incorporate an active systemic agent, docetaxel, as consolidation therapy. Methods Patients with histologically proven and radiologically defined T3 to 4, N0 to 1, M0 superior sulcus non-small cell lung cancer underwent induction therapy with cisplatin-etoposide, concurrently with thoracic radiotherapy at 45 Gy. Nonprogressing patients underwent surgical resection within 7 weeks. Consolidation consisted of docetaxel every 3 weeks for 3 doses. The accrual goal was 45 eligible patients. The primary objective was feasibility. Results Of 46 patients registered, 44 were eligible and assessable; 38 (86{\%}) completed induction, 29 (66{\%}) underwent surgical resection, and 20 (45{\%} of eligible, 69{\%} surgical, and 91{\%} of those initiating consolidation therapy) completed consolidation docetaxel; 28 of 29 (97{\%}) underwent a complete (R0) resection; 2 (7{\%}) died of adult respiratory distress syndrome. In resected patients, 21 of 29 (72{\%}) had a pathologic complete or nearly complete response. The known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, with 7 in the brain only. The 3-year progression-free survival was 56{\%}, and 3-year overall survival was 61{\%}. Conclusions Although trimodality therapy provides excellent R0 and local control, only 66{\%} of patients underwent surgical resection and only 45{\%} completed the treatment regimen. Even in this subset, distant recurrence continues to be a major problem, particularly brain-only relapse. Future strategies to improve treatment outcomes in this patient population must increase the effectiveness of systemic therapy and reduce the incidence of brain-only metastases.",
author = "Kernstine, {Kemp H.} and James Moon and Kraut, {Michael J.} and Pisters, {Katherine M W} and Sonett, {Joshua R.} and Rusch, {Valerie W.} and Thomas, {Charles R.} and Waddell, {Thomas K.} and Jett, {James R.} and Lyss, {Alan P.} and Keller, {Steven M.} and Gandara, {David R}",
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T1 - Trimodality therapy for superior sulcus non-small cell lung cancer

T2 - Southwest oncology group-intergroup trial s0220

AU - Kernstine, Kemp H.

AU - Moon, James

AU - Kraut, Michael J.

AU - Pisters, Katherine M W

AU - Sonett, Joshua R.

AU - Rusch, Valerie W.

AU - Thomas, Charles R.

AU - Waddell, Thomas K.

AU - Jett, James R.

AU - Lyss, Alan P.

AU - Keller, Steven M.

AU - Gandara, David R

PY - 2014

Y1 - 2014

N2 - Background Although preoperative chemotherapy (cisplatin-etoposide) and radiotherapy, followed by surgical resection, is considered a standard of care for superior sulcus cancers, treatment is rigorous and relapse limits long-term survival. The Southwest Oncology Group-Intergroup Trial S0220 was designed to incorporate an active systemic agent, docetaxel, as consolidation therapy. Methods Patients with histologically proven and radiologically defined T3 to 4, N0 to 1, M0 superior sulcus non-small cell lung cancer underwent induction therapy with cisplatin-etoposide, concurrently with thoracic radiotherapy at 45 Gy. Nonprogressing patients underwent surgical resection within 7 weeks. Consolidation consisted of docetaxel every 3 weeks for 3 doses. The accrual goal was 45 eligible patients. The primary objective was feasibility. Results Of 46 patients registered, 44 were eligible and assessable; 38 (86%) completed induction, 29 (66%) underwent surgical resection, and 20 (45% of eligible, 69% surgical, and 91% of those initiating consolidation therapy) completed consolidation docetaxel; 28 of 29 (97%) underwent a complete (R0) resection; 2 (7%) died of adult respiratory distress syndrome. In resected patients, 21 of 29 (72%) had a pathologic complete or nearly complete response. The known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, with 7 in the brain only. The 3-year progression-free survival was 56%, and 3-year overall survival was 61%. Conclusions Although trimodality therapy provides excellent R0 and local control, only 66% of patients underwent surgical resection and only 45% completed the treatment regimen. Even in this subset, distant recurrence continues to be a major problem, particularly brain-only relapse. Future strategies to improve treatment outcomes in this patient population must increase the effectiveness of systemic therapy and reduce the incidence of brain-only metastases.

AB - Background Although preoperative chemotherapy (cisplatin-etoposide) and radiotherapy, followed by surgical resection, is considered a standard of care for superior sulcus cancers, treatment is rigorous and relapse limits long-term survival. The Southwest Oncology Group-Intergroup Trial S0220 was designed to incorporate an active systemic agent, docetaxel, as consolidation therapy. Methods Patients with histologically proven and radiologically defined T3 to 4, N0 to 1, M0 superior sulcus non-small cell lung cancer underwent induction therapy with cisplatin-etoposide, concurrently with thoracic radiotherapy at 45 Gy. Nonprogressing patients underwent surgical resection within 7 weeks. Consolidation consisted of docetaxel every 3 weeks for 3 doses. The accrual goal was 45 eligible patients. The primary objective was feasibility. Results Of 46 patients registered, 44 were eligible and assessable; 38 (86%) completed induction, 29 (66%) underwent surgical resection, and 20 (45% of eligible, 69% surgical, and 91% of those initiating consolidation therapy) completed consolidation docetaxel; 28 of 29 (97%) underwent a complete (R0) resection; 2 (7%) died of adult respiratory distress syndrome. In resected patients, 21 of 29 (72%) had a pathologic complete or nearly complete response. The known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, with 7 in the brain only. The 3-year progression-free survival was 56%, and 3-year overall survival was 61%. Conclusions Although trimodality therapy provides excellent R0 and local control, only 66% of patients underwent surgical resection and only 45% completed the treatment regimen. Even in this subset, distant recurrence continues to be a major problem, particularly brain-only relapse. Future strategies to improve treatment outcomes in this patient population must increase the effectiveness of systemic therapy and reduce the incidence of brain-only metastases.

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