C Dickhoff1, K J Hartemink2, P M van de Ven3, E J F van Reij4, S Senan4, M A Paul5, E F Smit6, M Dahele4. 1. Department of Cardio-Thoracic Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: chrisdickhoff@yahoo.com. 2. Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands. 3. Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. 4. Department of Radiation Oncology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. 5. Department of Cardio-Thoracic Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. 6. Department of Pulmonary Diseases, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Abstract
OBJECTIVES: Although the standard treatment for patients with stage IIIA non-small cell lung cancer (NSCLC) is chemoradiotherapy, some patients are considered for trimodality therapy [TT]. We analyzed outcomes for stage IIIA NSCLC, treated with TT and compared them with concurrent chemoradiotherapy [con-CRT]. MATERIALS AND METHODS: Patients treated between January 2007 and December 2011 were retrospectively analyzed. Not included were patients with sulcus superior tumors, unknown T/N-status, or recurrent disease after con-CRT followed by surgery. All patients were discussed at our multidisciplinary thoracic tumor board (MTB). RESULTS: Mean Charlson Comorbidity Index was 2 for TT and con-CRT patients. TT patients were younger (median TT=56 years vs. con-CRT=62 years; p=0.001) and had less advanced cN-stage (TT cN2=41% vs. 83% for CRT; p<0.001). 44% of TT patients had T4-stage vs. 12% of con-CRT patients. Median RT dose was lower for TT (50 Gy vs. 66 Gy; p=0.001) and median RT planning target volume (PTV) in TT and con-CRT patients was 525 cm(3) and 655 cm(3) (p=0.010), respectively. The majority of TT patients had a lobectomy (23/32). Median follow-up was 30.3 months (95% CI=18.7-41.9) for TT and 51 months (95% CI=24.9-77.4) for con-CRT. Median overall survival was not reached for TT and was 18.6 months (95% CI=12.8-24.4) for con-CRT (p=0.001). For PTV</≥500 cm(3), median OS for TT was not reached/33.9 months and 29.1/17.1 months for con-CRT. TT patients with cN0/1 had better survival than those receiving con-CRT (p=0.015), but those with cN2 did not (p=0.158). The 90-day mortality from start of RT was 0% (0/32) for TT and 1.7% (1/58) for con-CRT. 90-day post-operative mortality for TT was 3.1% (1/32, event unrelated to TT). CONCLUSIONS: Selected patients with IIIA NSCLC treated with TT had favorable long-term survival with acceptable short-term mortality. These outcomes support the decision-making and function of our MTB/treatment team. The role of TT in cN2 disease and large tumors merits further evaluation.
OBJECTIVES: Although the standard treatment for patients with stage IIIA non-small cell lung cancer (NSCLC) is chemoradiotherapy, some patients are considered for trimodality therapy [TT]. We analyzed outcomes for stage IIIA NSCLC, treated with TT and compared them with concurrent chemoradiotherapy [con-CRT]. MATERIALS AND METHODS:Patients treated between January 2007 and December 2011 were retrospectively analyzed. Not included were patients with sulcus superior tumors, unknown T/N-status, or recurrent disease after con-CRT followed by surgery. All patients were discussed at our multidisciplinary thoracic tumor board (MTB). RESULTS: Mean Charlson Comorbidity Index was 2 for TT and con-CRT patients. TTpatients were younger (median TT=56 years vs. con-CRT=62 years; p=0.001) and had less advanced cN-stage (TTcN2=41% vs. 83% for CRT; p<0.001). 44% of TTpatients had T4-stage vs. 12% of con-CRT patients. Median RT dose was lower for TT (50 Gy vs. 66 Gy; p=0.001) and median RT planning target volume (PTV) in TT and con-CRT patients was 525 cm(3) and 655 cm(3) (p=0.010), respectively. The majority of TTpatients had a lobectomy (23/32). Median follow-up was 30.3 months (95% CI=18.7-41.9) for TT and 51 months (95% CI=24.9-77.4) for con-CRT. Median overall survival was not reached for TT and was 18.6 months (95% CI=12.8-24.4) for con-CRT (p=0.001). For PTV</≥500 cm(3), median OS for TT was not reached/33.9 months and 29.1/17.1 months for con-CRT. TTpatients with cN0/1 had better survival than those receiving con-CRT (p=0.015), but those with cN2 did not (p=0.158). The 90-day mortality from start of RT was 0% (0/32) for TT and 1.7% (1/58) for con-CRT. 90-day post-operative mortality for TT was 3.1% (1/32, event unrelated to TT). CONCLUSIONS: Selected patients with IIIA NSCLC treated with TT had favorable long-term survival with acceptable short-term mortality. These outcomes support the decision-making and function of our MTB/treatment team. The role of TT in cN2 disease and large tumors merits further evaluation.
Authors: Pieter J M Joosten; Chris Dickhoff; Vincent van der Noort; Maarten Smeekens; Rachel C Numan; Houke M Klomp; Judi N A van Diessen; Jose S A Belderbos; Egbert F Smit; Kim Monkhorst; Jan W A Oosterhuis; Michel M van den Heuvel; Max Dahele; Koen J Hartemink Journal: Interact Cardiovasc Thorac Surg Date: 2022-03-31