Seth B Krantz1, Brian Mitzman2, Waseem Lutfi3, Kristine Kuchta4, Chi-Hsiung Wang4, John A Howington5, Ki Wan Kim6. 1. Department of Surgery, NorthShore University Health System, Evanston, Illinois; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Electronic address: skrantz@northshore.org. 2. Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois. 3. Department of Surgery, NorthShore University Health System, Evanston, Illinois. 4. Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, Illinois. 5. Department of Surgery, Saint Thomas Healthcare, Nashville, Tennessee. 6. Department of Surgery, NorthShore University Health System, Evanston, Illinois; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
Abstract
BACKGROUND: For operable patients with clinical stage IIIA non-small cell lung cancer, the optimum neoadjuvant treatment strategy remains unclear. Our aim was to compare perioperative and long-term outcomes for patients receiving neoadjuvant chemoradiotherapy (NCRT) versus neoadjuvant chemotherapy (NCT) alone. METHODS: We queried the National Cancer Database to identify all patients with N2 and either T1-T2 non-small cell lung cancer who received either NCRT or NCT followed by lobectomy between 2006 and 2012. Patients with T3 tumors were excluded. A propensity match analysis was performed incorporating preoperative variables, and the incidence of postoperative complications, pathologic downstaging, and long-term survival were compared. RESULTS: In all, 1,936 patients met criteria, 745 NCT and 1,191 NCRT. The NCRT patients were younger, less likely to be treated at an academic medical center, and more likely to have adenocarcinoma. After propensity matching, patients in the NCT group showed lower 30-day mortality (1.3% versus 2.9%) and 90-day mortality (2.9% versus 6.0%), and were more likely to undergo a minimally invasive resection (25.7% versus 14.1%). The NCRT patients were more likely to have a pathologic complete response (14.2% versus 4.0%) and to be N0 at the time of resection (45.2% versus 38.7%). In the multivariable analysis, NCRT patients were at a greater risk of mortality than NCT patients (hazard ratio 1.18, 95% confidence interval: 1.03 to 1.36). CONCLUSIONS: In our cohort, combined neoadjuvant chemotherapy and radiation therapy was associated with improved pathologic downstaging but showed increased perioperative mortality with no improvement in long-term overall survival. For stage IIIA patients with smaller tumors without local invasion, chemotherapy alone may be the preferred neoadjuvant treatment.
BACKGROUND: For operable patients with clinical stage IIIA non-small cell lung cancer, the optimum neoadjuvant treatment strategy remains unclear. Our aim was to compare perioperative and long-term outcomes for patients receiving neoadjuvant chemoradiotherapy (NCRT) versus neoadjuvant chemotherapy (NCT) alone. METHODS: We queried the National Cancer Database to identify all patients with N2 and either T1-T2 non-small cell lung cancer who received either NCRT or NCT followed by lobectomy between 2006 and 2012. Patients with T3 tumors were excluded. A propensity match analysis was performed incorporating preoperative variables, and the incidence of postoperative complications, pathologic downstaging, and long-term survival were compared. RESULTS: In all, 1,936 patients met criteria, 745 NCT and 1,191 NCRT. The NCRT patients were younger, less likely to be treated at an academic medical center, and more likely to have adenocarcinoma. After propensity matching, patients in the NCT group showed lower 30-day mortality (1.3% versus 2.9%) and 90-day mortality (2.9% versus 6.0%), and were more likely to undergo a minimally invasive resection (25.7% versus 14.1%). The NCRT patients were more likely to have a pathologic complete response (14.2% versus 4.0%) and to be N0 at the time of resection (45.2% versus 38.7%). In the multivariable analysis, NCRT patients were at a greater risk of mortality than NCT patients (hazard ratio 1.18, 95% confidence interval: 1.03 to 1.36). CONCLUSIONS: In our cohort, combined neoadjuvant chemotherapy and radiation therapy was associated with improved pathologic downstaging but showed increased perioperative mortality with no improvement in long-term overall survival. For stage IIIA patients with smaller tumors without local invasion, chemotherapy alone may be the preferred neoadjuvant treatment.
Authors: Matthew J Bott; Stephen C Yang; Bernard J Park; Prasad S Adusumilli; Valerie W Rusch; James M Isbell; Robert J Downey; Julie R Brahmer; Richard Battafarano; Errol Bush; Jamie Chaft; Patrick M Forde; David R Jones; Stephen R Broderick Journal: J Thorac Cardiovasc Surg Date: 2018-12-13 Impact factor: 5.209
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: K Sinn; B Mosleh; A Steindl; S Zoechbauer-Mueller; K Dieckmann; J Widder; E Steiner; W Klepetko; K Hoetzenecker; V Laszlo; B Doeme; T Klikovits; M A Hoda Journal: ESMO Open Date: 2022-04-06