BACKGROUND: Although concurrent chemoradiation therapy can cure stage IIIA non-small cell lung cancer (NSCLC), studies have demonstrated that anatomic resection following high-dose or standard-dose chemoradiation may benefit selected patients. We examined morbidity and mortality associated with 3 multimodality treatment regimens for stage IIIA disease. METHODS: Institutional databases identified patients with stage IIIA (N2) NSCLC who underwent concurrent platinum-based chemoradiotherapy with or without pulmonary resection between 1998 and 2011. Exclusion criteria included palliative regimens, sequential chemoradiotherapy, radiation-surgery interval greater than 12 weeks, superior sulcus tumors, or radiotherapy other than standard external beam radiation. Treatment-related morbidity and mortality were examined for the following treatment regimens: neoadjuvant chemoradiotherapy with 45 Gy followed by surgery (trimodality-45); neoadjuvant chemoradiotherapy with 60 Gy or more followed by surgery (trimodality-60); and definitive chemoradiotherapy with 60 Gy or more without surgery (D-CRT). RESULTS: During the study period, 144 patients met eligibility criteria including 27 trimodality-45, 29 trimodality-60, and 88 D-CRT patients. Treatment-related morbidity and mortality rates for D-CRT were 74% [65 of 88] and 2.3% [2 of 88], respectively. Postoperative morbidity and mortality rates for patients who proceeded to surgery were 48% [27 of 56] and 1.8% [1 of 56], respectively, and did not differ based on dose of neoadjuvant radiation. Despite varied anatomic resections and methods of bronchial closure and coverage, no bronchopleural fistulae were observed. CONCLUSIONS: Chemoradiotherapy carries a significant morbidity profile. However, high-dose neoadjuvant radiation is not associated with increased postoperative morbidity or mortality relative to standard-dose radiation in patients selected for anatomic resection.
BACKGROUND: Although concurrent chemoradiation therapy can cure stage IIIA non-small cell lung cancer (NSCLC), studies have demonstrated that anatomic resection following high-dose or standard-dose chemoradiation may benefit selected patients. We examined morbidity and mortality associated with 3 multimodality treatment regimens for stage IIIA disease. METHODS: Institutional databases identified patients with stage IIIA (N2) NSCLC who underwent concurrent platinum-based chemoradiotherapy with or without pulmonary resection between 1998 and 2011. Exclusion criteria included palliative regimens, sequential chemoradiotherapy, radiation-surgery interval greater than 12 weeks, superior sulcus tumors, or radiotherapy other than standard external beam radiation. Treatment-related morbidity and mortality were examined for the following treatment regimens: neoadjuvant chemoradiotherapy with 45 Gy followed by surgery (trimodality-45); neoadjuvant chemoradiotherapy with 60 Gy or more followed by surgery (trimodality-60); and definitive chemoradiotherapy with 60 Gy or more without surgery (D-CRT). RESULTS: During the study period, 144 patients met eligibility criteria including 27 trimodality-45, 29 trimodality-60, and 88 D-CRT patients. Treatment-related morbidity and mortality rates for D-CRT were 74% [65 of 88] and 2.3% [2 of 88], respectively. Postoperative morbidity and mortality rates for patients who proceeded to surgery were 48% [27 of 56] and 1.8% [1 of 56], respectively, and did not differ based on dose of neoadjuvant radiation. Despite varied anatomic resections and methods of bronchial closure and coverage, no bronchopleural fistulae were observed. CONCLUSIONS: Chemoradiotherapy carries a significant morbidity profile. However, high-dose neoadjuvant radiation is not associated with increased postoperative morbidity or mortality relative to standard-dose radiation in patients selected for anatomic resection.
Authors: Young Kwang Chae; Ayush Arya; Wade Iams; Marcello Cruz; Nisha Mohindra; Victoria Villaflor; Francis J Giles Journal: Ann Transl Med Date: 2018-03
Authors: Sara Montemuiño; Núria Rodriguez de Dios; Margarita Martín; Begoña Taboada; Patricia Calvo-Crespo; María Pilar Samper-Ots; José Luis López-Guerra; M López-Mata; Josep Jové-Teixidó; Verónica Díaz-Díaz; Lourdes de Ingunza-Barón; Mauricio Murcia-Mejía; Marisa Chust; Tamara García-Cañibano; María Luz Couselo; María Mar Puertas; Elia Del Cerro; Javier Moradiellos; Sergio Amor; A Varela; I J Thuissard; David Sanz-Rosa; Felipe Couñago Journal: Rep Pract Oncol Radiother Date: 2020-03-18
Authors: Kevin X Liu; Kailan Sierra-Davidson; Kevin Tyan; Lawrence T Orlina; J Paul Marcoux; Benjamin H Kann; David E Kozono; Raymond H Mak; Abby White; Lisa Singer Journal: Radiother Oncol Date: 2021-10-22 Impact factor: 6.280
Authors: William G Breen; Kenneth W Merrell; Aaron S Mansfield; Dennis A Wigle; Yolanda I Garces; Sean S Park; Kenneth R Olivier; Christopher L Hallemeier Journal: Adv Radiat Oncol Date: 2016-12-21