Although preoperative chemotherapy (cisplatin-etoposide) and radiation followed by surgery is considered a standard-of-care for superior sulcus (SS) cancers, treatment is rigorous and relapse limits long term survival. S0220 was designed to incorporate an active systemic agent, (docetaxel) as consolidation therapy.
Patients with histologically-proven and radiologically-defined T3-T4, N0-N1, M0 SS NSCLC underwent induction therapy with cisplatin-etoposide, concurrently with thoracic RT 45 Gy. Non-progressing 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.
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; 28/29 (97%) underwent a complete (R0) resection; 2 (7%) died of ARDS. In resected patients, 21/29 (72%) had a pathologic complete or near complete response. Known site of first recurrence was local (2), local-systemic (1) and systemic (10), 7 in the brain only. The 3-year progression-free survival is 56% and 3-year overall survival is 61%.
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.