F Couñago1,2, S Montemuiño3, M Martin4, B Taboada5, P Calvo-Crespo5, M P Samper-Ots6, P Alcántara7, J Corona7, J L López-Guerra8, M Murcia-Mejía9, M López-Mata10, J Jové-Teixidó11, M Chust12, V Díaz-Díaz13, L de Ingunza-Barón13, T García-Cañibano3, M L Couselo14, E Del Cerro15,16, J Moradiellos17, S Amor17, A Varela17, M M Puertas18, I J Thuissard19, D Sanz-Rosa19, N R de Dios20,21. 1. Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez1, 1, Pozuelo de Alarcón, 28223, Madrid, Spain. felipe.counago@quironsalud.es. 2. Universidad Europea de Madrid, Calle Tajo, s/n, Villaviciosa de Odón, 28670, Madrid, Spain. felipe.counago@quironsalud.es. 3. Department of Radiation Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain. 4. Department of Radiation Oncology, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo Km9, Madrid, Spain. 5. Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Choupana s/n, bloque d. Santiago de Compostela, A Coruña, Spain. 6. Department of Radiation Oncology, Hospital Universitario Rey Juan Carlos, C/Gladiolo s/n. Móstoles, Madrid, Spain. 7. Department of Radiation Oncology, Hospital Universitario Clínico San Carlos, C/Prof, Martín Lagos s/n, Madrid, Spain. 8. Department of Radiation Oncology, Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, S/N, 41013, Seville, Spain. 9. Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Av. del Dr. Josep Laporte, 2, 43204, Reus, Tarragona, Spain. 10. Department of Radiation Oncology, Hospital Clinico Universitario Lozano Blesa, San Juan Bosco 15, Zaragoza, Spain. 11. Department of Radiation Oncology, Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain. 12. Department of Radiation Oncology, Instituto Valenciano de Oncologia, Carrer del Professor Beltrán Báguena, 8, 46009, Valencia, Spain. 13. Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cadiz, Spain. 14. Department of Radiation Oncology, Hospital Central de la Defensa Gomez Ulla, Glorieta Ejército, 1, 28047, Madrid, Spain. 15. Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez1, 1, Pozuelo de Alarcón, 28223, Madrid, Spain. 16. Universidad Europea de Madrid, Calle Tajo, s/n, Villaviciosa de Odón, 28670, Madrid, Spain. 17. Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/Diego de Velázquez, 1, Pozuelo de Alarcón, 28223, Madrid, Spain. 18. Department of Radiation Oncology, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain. 19. School of Doctoral Studies and Research, Universidad Europea, Calle Tajo, s/n, Villaviciosa de Odón, 28670, Madrid, Spain. 20. Department of Radiation Oncology, Hospital del Mar. Passeig Marítim, 25-29, 08003, Barcelona, Spain. 21. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Abstract
PURPOSE: To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). METHODS: A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was performed. RESULTS: Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5 months (5-128 months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0-pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen. CONCLUSIONS: In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patients.
PURPOSE: To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). METHODS: A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was performed. RESULTS: Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5 months (5-128 months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0-pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen. CONCLUSIONS: In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patients.
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