Purpose: Trimodality therapy incorporating preoperative chemotherapy (cisplatin-etoposide, CisP/Etop), radiation, and surgery is generally considered the standard of care for Superior Sulcus (SS) cancers. Intergroup SWOG 9416 demonstrated 5-year survival of 44%, with relapse mainly in distant sites. To address this issue, S0220 was designed to substitute single-agent docetaxel (DTX) for CisP/Etop during the consolidation phase after surgery.
Methods: Similar to S9416, patients with histologically proven and radiologically defined T3 -T4, N0-N1, M0 SS NSCLC underwent induction therapy for 2 cycles concurrently with radiation therapy (45 Gy). Non-progressing patients were to undergo surgical resection within 7 weeks after completion. Consolidation DTX 75 mg/m2 IV was planned every 3 weeks for 3 doses.
Results: From 7/03 to 10/07, 46 patients were registered with 44 eligible. 38 (86%) completed induction, 29 (66%) underwent surgical resection, and 20 (45%) completed the entire treatment regimen; 69% of surgically resected and 90% of those initiating consolidation DTX completed therapy. 28/29 (97%) underwent a complete (R0) resection, 2 (7%) died, both of ARDS. Surgical complications occurred in 55%; 31% had atrial fibrillation. Of the eligible, known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, 7 of them in the brain only. The 3-y PFS is 56% (95% CI 40% – 70%) and 3-y OS is 61% (44%-74%). These results are not dissimilar from the other SS induction group trials.
Conclusions: This trimodality therapy approach provides an excellent R0 and local control, but distant failure continues to be the most common site or relapse and cause of death, particularly brain recurrence. Strategies to improve treatment outcomes must address both improved systemic therapy and the high incidence of brain relapse.

Source: STS.