TREATMENT OF MODIFIED STAGE-II (T1 N1 M0, T2 N1 M0) NON-SMALL CELL BRONCHOGENIC-CARCINOMA - A COMBINED MODALITY APPROACH

Abstract

Twenty patients with postsurgical, modified Stage II (T2 N1 M0, T1 N1 M0) non-small cell bronchogenic carcinoma were seen between 1974-1981 and were evaluated in a retrospective manner. Fifteen patients had [stage] T2 N1 M0 lesions; 5 patients had T1 N1 M0 disease. Eight patients were treated with surgical resection alone, of whom 7 have died, with a median survival of 12.0 mo. Four patients received surgical resection and postoperative radiation therapy, of whom 2 died, with a median survival not reached at 37 mo. Eight patients were treated with surgical resection, radiation therapy and adjuvant chemotherapy including cyclophosphamide (C), doxorubicin (A), methotrexate (M) and procarbazine (P). Six patients are alive and free of disease, with a median survival not yet reached at 72 mo. There is a significant survival advantage for the 12 patients treated with combined modality therapy (surgical resection + radiation therapy; surgical resection + radiation therapy + chemotherapy) compared to the 8 patients treated with SR [surgical resection] alone (P < 0.01), and for the 8 patients receiving chemotherapy vs. the 12 patients who did not (P < 0.01). In spite of thorough clinical and surgical staging, patients with T1 and T2 primary tumors with N1 disease have a high relapse rate, predominantly in metastatic sites. Adjuvant radiation therapy and chemotherapy appear to benefit these patients with modified Stage II non-small cell bronchogenic carcinoma.