Original article
General thoracic
Neoadjuvant Chemoradiation for Clinically Advanced Non-Small Cell Lung Cancer: An Analysis of 233 Patients

Presented at Fifty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 3–6, 2010.
https://doi.org/10.1016/j.athoracsur.2011.03.001Get rights and content

Background

Surgical intervention after chemoradiation for locoregionally advanced non-small cell lung cancer (NSCLC) is controversial. This study evaluated patient survival after neoadjuvant chemoradiation and anatomic pulmonary resections for locoregionally advanced NSCLC.

Methods

Clinicopathologic data were retrospectively collected for 233 patients (110 women, 123 men) with NSCLC who underwent chemoradiation therapy, followed by pneumonectomy, sleeve lobectomy, bilobectomy, and standard lobectomy, from 1989 to 2008. Univariate log-rank analysis of Kaplan-Meier survival curves and multivariate Cox regression analysis was performed.

Results

Final pathologic stages were complete responders, 52 (22%); I, 56 (24%); II, 39 (17%); and III, 86 (37%). Final pathologic lymph node status was N0, 130 (56%); N1, 28 (12%); and N2, 75 (32%). Overall 5-year survival for the cohort was 43%. The 90-day mortality was 8% (18 of 233). The 5-year survival was 33% for pneumectomy vs 51% for lobectomy (p = 0.002). Survival rates at 5 years by stage were complete responders, 58%; I, 50%; II, 41%; and III, 32%; by primary tumor status, T0, 50%; T2, 38%; T3, 29%; and T4, 28%; and by final pathologic nodal status, N0, 51%; N1, 40%; N2, 32% (N0 vs N1, p = 0.236; N1 vs N2, p = 0.704; N0 vs N2, p = 0.019; N0 vs N1 + N2, p = 0.020). Multivariate analysis demonstrated pneumonectomy was associated with decreased 5-year survival (hazard risk, 1.5162; 95% confidence interval, 10.05028 to 2.189, p = 0.0263).

Conclusions

Respectable survival can be achieved after neoadjuvant chemoradiation, followed by anatomic resection, in selected patients with clinically advanced NSCLC. A T0 primary tumor or N0 lymph node status individually, or together as a complete response (T0 N0) status, is associated with the best long-term survival. Survival is most favorable for lobectomies vs pneumonectomies after neoadjuvant chemoradiation therapy.

Section snippets

Material and Methods

The medical records of all patients undergoing anatomic pulmonary resection for NSCLC after neoadjuvant chemoradiation therapy at a Rush University Medical Center from January 1989 through December 2008 were recorded. Institutional Review Board approval was obtained to perform this retrospective study, and individual patient consent was waived.

Patients, generally, with clinically advanced NSCLC or histologically positive mediastinal lymph nodes were carefully selected for therapy by a

Results

We identified 233 patients who had undergone neoadjuvant chemoradiation therapy, followed by anatomic pulmonary resection (Table 1). These 233 patients represented those patients that who were successfully treated in the intent-to-treat trimodality paradigm and were 86% of the 272 patients in the total intent-to-treat population. Ultimately, 34 patients (14%) of the intent-to-treat population were excluded: 16 refused the surgical intervention, the disease progressed in 10, and 8 patients died.

Comment

The use of chemotherapy and radiotherapy in a neoadjuvant paradigm before anatomic pulmonary resection at Rush University Medical Center was largely based on the initially successful experience [6] and the subsequent respectable outcomes associated with its use [1, 4, 7, 8, 9] by the multidisciplinary lung cancer team. The successful experiences of others [10, 11, 12] have served to further support its use. Despite these favorable outcomes, the challenge remains in identifying those patients

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