World Journal of Surgery

, Volume 36, Issue 12, pp 2858–2864 | Cite as

Hyperfractionated Irradiation with 3 Cycles of Induction Chemotherapy in Stage IIIA-N2 Lung Cancer

  • Fengshi Chen
  • Kenichi Okubo
  • Makoto Sonobe
  • Keiko Shibuya
  • Yukinori Matsuo
  • Young Hak Kim
  • Kazuhiro Yanagihara
  • Toru Bando
  • Hiroshi DateEmail author



The purpose of the present study was to improve the prognosis of patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). To achieve that goal, we performed induction chemoradiotherapy followed by surgery.


The criteria for this phase II study were ≤75-year-old patients with pathologically diagnosed stage IIIA-N2 NSCLC who had performance statuses of 0 or 1 with good organ function. Three cycles of chemotherapy with paclitaxel and carboplatin were carried out, with concurrent hyperfractionated irradiation (42 Gy). After re-evaluation, pulmonary resections were considered unless patients showed progressive disease. The primary endpoint was overall survival (OS), and the secondary endpoints were disease-free survival (DFS) and absence of toxicity.


All 22 patients enrolled in this study completed the induction chemoradiotherapy without any severe complications. In these 22 patients, the 2- and 5-year OS were 81 and 47 %, respectively. There were no therapy-related deaths. Surgery was subsequently performed in 19 patients (86 %). Pathological complete responses were seen in 6 patients (27 %), while node downstaging was obtained in 10 patients (45 %). In the 19 patients who underwent surgery, the 2- and 5-year OS rates were 83 and 62 %, respectively, and the 2-year DFS rate was 63 %. All 6 patients with pathological complete responses survived without disease. Patients with residual multiple-station N2 showed worse OS and DFS rates than did those with downstaged and single-station N2 (P = 0.026 and P < 0.0001, respectively).


This trimodal therapy was effective and well tolerated, and it is an acceptable therapeutic option for patients with locally advanced stage IIIA-N2 NSCLC. Patients without persistent multiple-station N2 showed promising survival.


Overall Survival Paclitaxel Carboplatin Adenoid Cystic Carcinoma Radiation Pneumonitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Fengshi Chen
    • 1
  • Kenichi Okubo
    • 1
  • Makoto Sonobe
    • 1
  • Keiko Shibuya
    • 2
  • Yukinori Matsuo
    • 2
  • Young Hak Kim
    • 3
  • Kazuhiro Yanagihara
    • 4
  • Toru Bando
    • 1
  • Hiroshi Date
    • 1
    Email author
  1. 1.Department of Thoracic SurgeryKyoto UniversityKyotoJapan
  2. 2.Department of Radiation Oncology and Image-Applied TherapyKyoto UniversityKyotoJapan
  3. 3.Department of Respiratory MedicineKyoto UniversityKyotoJapan
  4. 4.Outpatient Oncology UnitKyoto UniversityKyotoJapan

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