Abstract
Background The aim of this study was to explore the feasibility of surgery after two induction
cycles of cisplatin-docetaxel followed by concomitant 40 Gy chemoradiation in the
treatment of initially unresectable stage III non–small cell lung cancer (NSCLC; TAXCIS
protocol), and to evaluate overall survival (OS) and recurrence-free survival (RFS)
and recurrence risk factors over a larger cohort of patients with a subgroup analysis
of patients treated by pneumonectomy.
Methods Between 2004 and 2014, a total of 37 patients were treated. Only patients responding
to induction treatment were included.
Results We operated on 32 stage IIIA and 5 stage IIIB patients. We performed 12 pneumonectomies,
1 bilobectomy, and 23 lobectomies. Status ypT0N0 was obtained for 35% of the patients.
Surgery was considered R0 in 86% of the cases. Postoperative morbidity was 21.6% with
a mortality of 10.8% (25% after pneumonectomy). OS was 50% at 5 years. The median
RFS was 50 months. RFS was 47% at 5 years. Local or locoregional recurrence was diagnosed
in 10.8% of the patients, and distant metastasis in 35.1%. Recurrence risk factors
were pneumonectomy (p = 0.001) and a histologically incomplete response (p = 0.04).
Conclusion The TAXCIS protocol followed by surgery is feasible for initially unresectable NSCLC
stage IIIA and B patients. Benefit was noted in responding lesions with better OS
and PFS, except after pneumonectomy.
Keywords
lung cancer - radiation therapy - chemotherapy
