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

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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 Montemuiño1, Núria Rodriguez Dios23, Margarita Martín4, Begoña Taboada5, Patricia Calvo-Crespo5, María Pilar Samper-Ots6, José Luis López-Guerra7, M. López-Mata8, Josep Jové-Teixidó9, Verónica Díaz-Díaz10, Lourdes de Ingunza-Barón10, Mauricio Murcia-Mejía11, Marisa Chust12, Tamara García-Cañibano1, María Luz Couselo13, María Mar Puertas14, Elia del Cerro1516, Javier Moradiellos17, Sergio Amor17, A. Varela17, I.J. Thuissard18, David Sanz-Rosa18, Felipe Couñago1516
DOI: 10.1016/j.rpor.2020.03.006
Rep Pract Oncol Radiother 2020;25(3):447-455.

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.

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Reports of Practical Oncology and Radiotherapy