Combined regional and systemic chemotherapy for advanced and inoperable non-small cell lung cancer

Aims: The objective was to establish the feasibility and toxicity of regional chemotherapy using an isolated thoracic perfusion (ITP) technique plus low dose systemic chemotherapy as induction chemotherapy followed by surgery in advanced non-small cell lung cancer (NSCLC). Methods: twenty-two chemotherapy-naive patients with NSCLC (median age of 57 years, stage III–IV disease with metastases only in the thoracic region, Karnofsky index >60), received two cycles of regional plus systemic chemotherapy with a treatment-free interval of 4 weeks. The cytostatic regimen consisted of 10 mg/m2mitomycin, 25 mg/m2 navelbine and 30 mg/m2 cisplatin during ITP followed by low-dose systemic chemotherapy with 250 mg/m2 5-fluorouracil and 20 mg/m2 cisplatin given as a continuous infusion on day 1–4. Patients were re-evaluated for response and surgery was carried out if possible. Results: All 22 patients could be assessed for toxicity, response and survival. There were 19/22 remissions corresponding to a regression rate of 86.4%; 16/22 patients could be resected. This corresponded to a resectability rate of 72.7% (13 complete resections R0, 1 R1, 2 R2). Side-effects were transient and acceptable with no treatment- or surgery-related deaths. Median survival has not been reached after an observation time of 15 months. The estimated 1-year survival rate was 67.3%. Conclusions: Regional chemotherapy using an ITP application form is highly effective in advanced NSCLC stage III–IV leading to a high rate of resectability with an encouraging survival outcome.