open access

Vol 25, No 3 (2020)
Original research articles
Published online: 2020-05-01
Submitted: 2019-08-20
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High-dose neoadjuvant chemoradiotherapy versus chemotherapy alone followed by surgery in potentially-resectable stage IIIA-N2 NSCLC. A multi-institutional retrospective study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society)

Sara Montemuiño, Núria Rodriguez 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
DOI: 10.1016/j.rpor.2020.03.006
·
Rep Pract Oncol Radiother 2020;25(3):447-455.

open access

Vol 25, No 3 (2020)
Original research articles
Published online: 2020-05-01
Submitted: 2019-08-20

Abstract

Background

The optimal induction treatment in potentially-resectable stage IIIA-N2 NSCLC remains undefined.

Aim

To compare neoadjuvant high-dose chemoradiotherapy (CRT) to neoadjuvant chemotherapy (CHT) in patients with resectable, stage IIIA-N2 non-small-cell lung cancer (NSCLC).

Methods

Retrospective, multicentre study of 99 patients diagnosed with stage cT1-T3N2M0 NSCLC who underwent neoadjuvant treatment (high-dose CRT or CHT) followed by surgery between January 2005 and December 2014.

Results

47 patients (47.5%) underwent CRT and 52 (52.5%) CHT, with a median follow-up of 41 months. Surgery consisted of lobectomy (87.2% and 82.7%, in the CRT and CHT groups, respectively) or pneumonectomy (12.8% vs. 17.3%). Nodal downstaging (to N1/N0) and Pathologic complete response (pCR; pT0pN0) rates were significantly higher in the CRT group (89.4% vs. 57.7% and 46.8% vs. 7.7%, respectively; p < 0.001)). Locoregional recurrence was significantly lower in the CRT group (8.5% vs. 13.5%; p = 0.047) but distant recurrence rates were similar in the two groups. Median PFS was 45 months (CHT) vs. “not reached” (CRT). Median OS was similar: 61 vs. 56 months (p = 0.803). No differences in grade ≥3 toxicity were observed. On the Cox regression analysis, advanced pT stage was associated with worse OS and PFS (p < 0.001) and persistent N2 disease (p = 0.002) was associated with worse PFS.

Conclusions

Compared to neoadjuvant chemotherapy alone, a higher proportion of patients treated with preoperative CRT achieved nodal downstaging and pCR with better locoregional control. However, there were no differences in survival. More studies are needed to know the optimal treatment of these patients.

Abstract

Background

The optimal induction treatment in potentially-resectable stage IIIA-N2 NSCLC remains undefined.

Aim

To compare neoadjuvant high-dose chemoradiotherapy (CRT) to neoadjuvant chemotherapy (CHT) in patients with resectable, stage IIIA-N2 non-small-cell lung cancer (NSCLC).

Methods

Retrospective, multicentre study of 99 patients diagnosed with stage cT1-T3N2M0 NSCLC who underwent neoadjuvant treatment (high-dose CRT or CHT) followed by surgery between January 2005 and December 2014.

Results

47 patients (47.5%) underwent CRT and 52 (52.5%) CHT, with a median follow-up of 41 months. Surgery consisted of lobectomy (87.2% and 82.7%, in the CRT and CHT groups, respectively) or pneumonectomy (12.8% vs. 17.3%). Nodal downstaging (to N1/N0) and Pathologic complete response (pCR; pT0pN0) rates were significantly higher in the CRT group (89.4% vs. 57.7% and 46.8% vs. 7.7%, respectively; p < 0.001)). Locoregional recurrence was significantly lower in the CRT group (8.5% vs. 13.5%; p = 0.047) but distant recurrence rates were similar in the two groups. Median PFS was 45 months (CHT) vs. “not reached” (CRT). Median OS was similar: 61 vs. 56 months (p = 0.803). No differences in grade ≥3 toxicity were observed. On the Cox regression analysis, advanced pT stage was associated with worse OS and PFS (p < 0.001) and persistent N2 disease (p = 0.002) was associated with worse PFS.

Conclusions

Compared to neoadjuvant chemotherapy alone, a higher proportion of patients treated with preoperative CRT achieved nodal downstaging and pCR with better locoregional control. However, there were no differences in survival. More studies are needed to know the optimal treatment of these patients.

Get Citation

Keywords

Non-small cell lung cancer (NSCLC); N2 disease; Neoadjuvant therapy; High dose radiation

About this article
Title

High-dose neoadjuvant chemoradiotherapy versus chemotherapy alone followed by surgery in potentially-resectable stage IIIA-N2 NSCLC. A multi-institutional retrospective study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society)

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 25, No 3 (2020)

Pages

447-455

Published online

2020-05-01

DOI

10.1016/j.rpor.2020.03.006

Bibliographic record

Rep Pract Oncol Radiother 2020;25(3):447-455.

Keywords

Non-small cell lung cancer (NSCLC)
N2 disease
Neoadjuvant therapy
High dose radiation

Authors

Sara Montemuiño
Núria Rodriguez 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

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