Surgery for NSCLC stages T1-3N2M0 having preoperative pathologically verified N2 involvement: A prospective randomized multinational phase III trial by the Nordic Thoracic Oncology Group.
Publication: Journal of Clinical Oncology
Abstract
7504
Background: Surgery is not generally considered standard of care in preoperative pathological verified spread to N2 mediastinal lymph nodes in NSCLC. Methods: Previously untreated histologically verified NSCLC stages T1-3N2M0 were randomized to reg. A (Paclitaxel 225 mg/m2 + Carboplatin AUC6 day 1 q 3 wks for 3 courses, followed by surgery with ipsilateral mediastinal lymph node sampling followed by radiotherapy 2Gy x 30 fractions, 5F/W) or reg. B: same as A without surgery (sequential chemo-radiotherapy). 406 pts were needed to detect a 10% 5-year survival increase with 80% power and type 1-error of 5%. The study was approved by ethical committees. Pts gave informed consent. Results: 170 pts were randomized to A and 171 to B from 1998-2009 when study closed due to concomitant chemo-radiotherapy becoming standard instead of sequential treatment. Median age was 61 years (range 33-76 yrs), 59% were males, 43% had performance status 0. Stages T1N2M0, T2N2M0, and T3N2M0 occurred in 19%, 60%, and 21%, respectively. Adenocarcinoma (ADC) and squamous cell carcinoma occurred in 50% and 29%, respectively. In reg. A, surgery was possible in 132 out of 170 pts (78%), 121 pts (71%) had complete resection while 11 pts (6%) had incomplete resection. Pathological-surgical stage pT0 occurred in 4%. Median progression free survival (PFS), OS and 5-years survival rate were 10 mths, 17 mths, and 20% for A (+ surgery) compared to 8 mths (p=0.144), 15 mths (p=0.172), and 16% (p=0.310) for B, respectively. ADC pts had better OS in A than in B (HR 0.60; p=0.002), and 5-year survivals 20% and 7% (p=0.017) respectively. Stage T1N2 had better OS in A than in B (HR 0.47; p=0.010), 5-year survivals 36% and 17%. Conclusions: There were no statistical overall significant advantage for surgery in addition to chemo-radiotherapy (A) compared to chemo-radiotherapy alone (B) but ADC pts and pts with T1N2 had significantly improved OS and 5-year survival rates in the surgery arm. Current standard treatment for T1-3N2M0 NSCLC is concomitant chemo-radiotherapy which was not used in this study, hence conclusions should be further tested with use of such treatment as reference arm.
Information & Authors
Information
Published In
Copyright
© 2013 by American Society of Clinical Oncology.
History
Published online: May 20, 2013
Published in print: May 20, 2013
Authors
Metrics & Citations
Metrics
Altmetric
Citations
Article Citation
Surgery for NSCLC stages T1-3N2M0 having preoperative pathologically verified N2 involvement: A prospective randomized multinational phase III trial by the Nordic Thoracic Oncology Group.. JCO 31, 7504-7504(2013).
Download Citation
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
Download article citation data for:
Journal of Clinical Oncology 2013 31:15_suppl, 7504-7504
Journal of Clinical Oncology 2013 31:15_suppl, 7504-7504
View Options
View options
Get Access
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
Purchase this article to get full access to it.
Subscribe
Subscribe to this Journal
Renew Your Subscription
Become a Member