Nicolas Zhou1, Matthew Bott2, Bernard J Park2, Eric Vallières3, Candice L Wilshire3, Kazuhiro Yasufuku4, Jonathan D Spicer5, David R Jones2, Boris Sepesi6. 1. Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex. 2. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 3. Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Wash. 4. Division of Thoracic Surgery, University Health Network - Toronto General Hospital, Toronto, Ontario, Canada. 5. Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, Québec, Canada. 6. Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex. Electronic address: bsepesi@mdanderson.org.
Abstract
BACKGROUND: Adjuvant chemotherapy, postoperative radiation (PORT), and prophylactic cranial irradiation (PCI) have been individually examined in limited-stage small cell lung cancer (SCLC). There is a paucity of data on the effectiveness of each adjuvant treatment modality when used in combination after surgical resection of SCLC. METHODS: Data were collected from 5 cancer centers on all patients with limited-stage SCLC who underwent surgical resection between 1986 and 2019. Univariate and multivariable models were conducted to identify predictors of long-term outcomes, focusing on freedom from recurrence and survival benefit of adjuvant chemotherapy, PORT, and PCI. RESULTS: A total of 164 patients were analyzed. Multivariable Cox regression analysis did not identify any adjuvant therapies to significantly influence recurrence in this cohort. Specifically, PORT was not associated with a significant influence on locoregional recurrence and PCI was not significantly associated with intracranial outcomes. Adjuvant chemotherapy improved survival in all stage I through III disease (hazard ratio, 0.49; 95% confidence interval, 0.29-0.81; P = .005) and even in pathologically node negative patients (hazard ratio, 0.49; 95% confidence interval, 0.27-0.91; P = .024). Although PCI was found to improve survival in univariate analysis, it was not significant in a multivariable model. PORT was not found to affect survival on either univariate or multivariable analysis. CONCLUSIONS: This is among the largest multi-institutional studies on surgically resected limited-stage SCLC. Our results highlight survival benefit of adjuvant chemotherapy, but did not identify a statistically significant influence from mediastinal PORT or PCI in our cohort. Larger prospective studies are needed to determine the benefit of PORT or PCI in a surgically resected limited-stage SCLC population.
BACKGROUND: Adjuvant chemotherapy, postoperative radiation (PORT), and prophylactic cranial irradiation (PCI) have been individually examined in limited-stage small cell lung cancer (SCLC). There is a paucity of data on the effectiveness of each adjuvant treatment modality when used in combination after surgical resection of SCLC. METHODS: Data were collected from 5 cancer centers on all patients with limited-stage SCLC who underwent surgical resection between 1986 and 2019. Univariate and multivariable models were conducted to identify predictors of long-term outcomes, focusing on freedom from recurrence and survival benefit of adjuvant chemotherapy, PORT, and PCI. RESULTS: A total of 164 patients were analyzed. Multivariable Cox regression analysis did not identify any adjuvant therapies to significantly influence recurrence in this cohort. Specifically, PORT was not associated with a significant influence on locoregional recurrence and PCI was not significantly associated with intracranial outcomes. Adjuvant chemotherapy improved survival in all stage I through III disease (hazard ratio, 0.49; 95% confidence interval, 0.29-0.81; P = .005) and even in pathologically node negative patients (hazard ratio, 0.49; 95% confidence interval, 0.27-0.91; P = .024). Although PCI was found to improve survival in univariate analysis, it was not significant in a multivariable model. PORT was not found to affect survival on either univariate or multivariable analysis. CONCLUSIONS: This is among the largest multi-institutional studies on surgically resected limited-stage SCLC. Our results highlight survival benefit of adjuvant chemotherapy, but did not identify a statistically significant influence from mediastinal PORT or PCI in our cohort. Larger prospective studies are needed to determine the benefit of PORT or PCI in a surgically resected limited-stage SCLC population.
Authors: Elliot Wakeam; Meredith Giuliani; Natasha B Leighl; Samuel R G Finlayson; Thomas K Varghese; Gail E Darling Journal: Ann Thorac Surg Date: 2017-03-03 Impact factor: 4.330
Authors: A T Turrisi; K Kim; R Blum; W T Sause; R B Livingston; R Komaki; H Wagner; S Aisner; D H Johnson Journal: N Engl J Med Date: 1999-01-28 Impact factor: 91.245
Authors: Susan E Combs; Jacquelyn G Hancock; Daniel J Boffa; Roy H Decker; Frank C Detterbeck; Anthony W Kim Journal: J Thorac Oncol Date: 2015-02 Impact factor: 15.609
Authors: Chi-Fu Jeffrey Yang; Derek Y Chan; Paul J Speicher; Brian C Gulack; Xiaofei Wang; Matthew G Hartwig; Mark W Onaitis; Betty C Tong; Thomas A D'Amico; Mark F Berry; David H Harpole Journal: J Clin Oncol Date: 2016-01-19 Impact factor: 44.544
Authors: Anna F Farago; Beow Y Yeap; Marcello Stanzione; Yin P Hung; Rebecca S Heist; J Paul Marcoux; Jun Zhong; Deepa Rangachari; David A Barbie; Sarah Phat; David T Myers; Robert Morris; Marina Kem; Taronish D Dubash; Elizabeth A Kennedy; Subba R Digumarthy; Lecia V Sequist; Aaron N Hata; Shyamala Maheswaran; Daniel A Haber; Michael S Lawrence; Alice T Shaw; Mari Mino-Kenudson; Nicholas J Dyson; Benjamin J Drapkin Journal: Cancer Discov Date: 2019-08-15 Impact factor: 39.397
Authors: Ramaswamy Govindan; Nathan Page; Daniel Morgensztern; William Read; Ryan Tierney; Anna Vlahiotis; Edward L Spitznagel; Jay Piccirillo Journal: J Clin Oncol Date: 2006-10-01 Impact factor: 44.544
Authors: Eric Vallières; Frances A Shepherd; John Crowley; Paul Van Houtte; Pieter E Postmus; Desmond Carney; Kari Chansky; Zeba Shaikh; Peter Goldstraw Journal: J Thorac Oncol Date: 2009-09 Impact factor: 15.609
Authors: Marc Bischof; Jürgen Debus; Klaus Herfarth; Thomas Muley; Jutta Kappes; Konstantina Storz; Hans Hoffmann Journal: Strahlenther Onkol Date: 2007-12 Impact factor: 3.621
Authors: Mathijs L Tomassen; Jacquelien Pomp; Janneke van der Stap; Anne S R van Lindert; Max Peters; José S A Belderbos; Dirk K M De Ruysscher; Steven H Lin; Joost J C Verhoeff; Peter S N van Rossum Journal: Clin Transl Radiat Oncol Date: 2022-02-17
Authors: Sean Coffey; Ross Roberts-Thomson; Alex Brown; Jonathan Carapetis; Mao Chen; Maurice Enriquez-Sarano; Liesl Zühlke; Bernard D Prendergast Journal: Nat Rev Cardiol Date: 2021-06-25 Impact factor: 32.419