Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society)

Couñago, Felipe; Rodríguez de Dios, Núria; Taboada, B.

Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society)

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dc.contributor.author Couñago, Felipe
dc.contributor.author Rodríguez de Dios, Núria
dc.contributor.author Taboada, B.
dc.date.accessioned 2018-12-05T08:33:56Z
dc.date.issued 2018
dc.description.abstract OBJECTIVES: The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT). MATERIAL AND METHODS: A total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group). RESULTS: Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p < 0.001) were significantly higher in the CRTS group. This survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup versus dCRT (OS: 57 vs 29 months, p < 0.001; PFS: 46 vs 15 months, p < 0.001), but not in the comparison between the pneumonectomy subgroup and dCRT. CONCLUSION: The findings reported here indicate that neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy) yields better OS and PFS than definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC.
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dc.identifier.citation Couñago F, Rodriguez de Dios N, Montemuiño S, Jové-Teixidó J, Martin M, Calvo-Crespo P. et al. Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society). Lung Cancer. 2018 Apr;118:119-127. DOI: 10.1016/j.lungcan.2018.02.008
dc.identifier.doi http://dx.doi.org/10.1016/j.lungcan.2018.02.008
dc.identifier.issn 0169-5002
dc.identifier.uri http://hdl.handle.net/10230/35991
dc.language.iso eng
dc.publisher Elsevier
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.subject.keyword Chemoradiation
dc.subject.keyword NSCLC
dc.subject.keyword Neoadjuvant treatment
dc.subject.keyword Surgery
dc.subject.keyword Stage IIIA
dc.subject.other Pulmons -- Càncer -- Quimioteràpia
dc.title Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society)
dc.type info:eu-repo/semantics/article
dc.type.version info:eu-repo/semantics/acceptedVersion

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