Background: The impact of adjuvant chemotherapy (CT) in the management of resectable non-small cell lung cancer (NSCLC) is highly debated. The aim of the study was to evaluate the outcome of this category of patients, treated at the Military Hospital Bucharest (surgery) and Institute of Oncology Bucharest (CT).
Patients and methods: We retrospectively analyzed the survival data according to various patients' characteristics, the corresponding pattern of relapses, along with the data concerning the CT program.
Results: A number of 311 consecutively treated patients (pts.), between January 1994 and October 2002, were evaluated. All patients were radically resected and received adjuvant CT. Chemotherapy was planned to be cisplatin-based and to be delivered for six cycles. In addition, 141 pts. (45%) received post-operative irradiation (RT). demographics: sex, M 252 (81%)/F 59 (19%) and median age: 58 (range 31-75). Stage: I 55 (17%), II 71 (23%), III A 140 (45%) and III B 45 (15%). After a median follow-up of 46 months, the overall median survival (MS), considering all the patients, was 42 months and the 5-year survival rate (5-year SR) was 44%. According to stage, MS and 5-year SR were as follows: Stage I = not reached/94%; Stage II = 54 months/59%; Stage III A = 28 months/37% and Stage III B= 18 months/27%. According to lymph node status, the MS was not reached for pN-negative pts. and 26 months for pN-positive pts. (P = 0.0002), while the 5-year SR was 75% versus 35%, respectively. Platinum-based CT was delivered in 295 pts. (95%). The medium number of cycles was five. A number of 86 (28%) relapses were recorded, of which 50 (16%) were distant, 25 (8%) local and 11 (4%) distant and local. The sites of the 50 distant relapses were BRA 24 (48%), OSS 10 (20%), PUL 6 (12%) and OTH 10 (20%).
Conclusion: Our analysis shows good long-term survival data for adjuvant CT following surgery in NSCLC, which looks comparatively superior to those communicated for surgery-only series. Pathologic invasion of the lymph nodes has a strong adverse effect on patients' outcome. The positive impact of CT in this setting is indirectly sustained by the pattern of relapses, which place the brain sanctuary on the first rank. Overall, the patients' compliance was good and we delivered a medium of five cycles of adjuvant platinum-based CT.