Value of accelerated multimodality therapy in stage IIIA and IIIB non–small cell lung cancer

Treatment schema for accelerated hyperfractionated chemoradiotherapy followed by resection and adjuvant, consolidative chemoradiation for patients with stage IIIA and stage IIIB NSCLC. Cisplatin dose was 20 mg · m⁻² · d⁻¹ for 4 days and paclitaxel dose was 175 mg · m⁻² as 24-hour infusion. CDDP, Cisplatin; BID RT, twice-daily radiotherapy at 1.5 Gy per fraction.

Postoperative survival after accelerated chemoradiotherapy. A, Survival. Each circle represents death positioned on vertical axis according to Kaplan-Meier estimator. These are accompanied by vertical bars representing asymmetric 68% confidence limits (equivalent to ±1 SE). Numbers in parentheses represent survivors at that interval. Smooth curve is parametric estimate of survival enclosed within dashed asymmetric 68% confidence bands. B, Hazard. Instantaneous risk of death (hazard function) is represented by solid curve enclosed within dashed 68% confidence limits. Although early risk is high, this hazard is of short duration, resulting in few early deaths.

Survival by pathologic stage. Both Kaplan-Meier (symbols) and parametric (curves) survival estimates are depicted as in Figure 2, A. Parametric estimates are truncated when remaining survivors are few. Patients with pathologic stage 0 to II had survival superior to those with residual N2 disease (stage IIIA), who in turn had longer survival than did nonresponders (stage IIIB, P < .001).

Good risk and poor risk patients. Shown at upper portion of graph is 45-year-old patient whose adenocarcinoma was sterilized by accelerated chemoradiotherapy. For comparison, we present same patient profile except with squamous cell carcinoma. Survival at bottom of graph is for 65-year-old patient who did not respond to therapy and was found to have T4 tumor at surgery. Two curves represent squamous and nonsquamous tumor histologic types.