Lobectomy and Mediastinal Radiochemotherapy in Unresectable Stage III Non-Small Cell Lung Cancer Responding to Induction Chemotherapy

Inclusion Criteria:

• Histological or cytological diagnosis of non-small cell carcinoma of the lung
• Initially stage III NSCLC
• Pathologically proven N2 or N3 disease
• Any response to induction chemotherapy (whatever the regimen administered)
• Disease still not fully resectable (because of extensive mediastinal N disease) and not suitable for radical radiotherapy (single field) after induction chemotherapy
• Lobectomy possible for the treatment of T disease
• Availability for participating in the detailed follow-up of the protocol
• Informed consent

Exclusion Criteria:

• Prior treatment with radiotherapy or surgery
• Karnofsky PS < 60
• Functional or anatomical contra-indication to mediastinal radiotherapy
• Functional or anatomical contra-indication to surgical lobectomy
• A history of prior malignant tumour, except non-melanoma skin cancer or in situ carcinoma of the cervix or cured malignant tumour (more than 5 year disease-free interval)
• Malignant pleural or pericardial effusion
• Neutrophils < 2,000/mm³
• Platelet cells < 100,000/mm3
• Serum bilirubin > 1.5 mg/100 ml
• Serum creatinine > 1.5 mg/100 ml and/or creatinine clearance < 60 ml/min
• Recent myocardial infarction (less than 3 months prior to date of diagnosis)
• Congestive cardiac failure or cardiac arrhythmia requiring medical treatment
• Uncontrolled infectious disease
• Hearing loss
• Symptomatic polyneuropathy
• Serious medical or psychological factors which may prevent adherence to the treatment schedule