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Couñago F, Rodriguez de Dios N, Montemuiño S, Jové-Teixidó J, Martin M, Calvo-Crespo P, López-Mata M, Samper-Ots MP, López-Guerra JL, García-Cañibano T, Díaz-Díaz V, de Ingunza-Barón L, Murcia-Mejía M, Alcántara P, Corona J, Puertas MM, Chust M, Couselo ML, Del Cerro E, Moradiellos J, Amor S, Varela A, Thuissard IJ, Sanz-Rosa D, 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). Lung Cancer 2018; 118:119-127. [PMID: 29571989 DOI: 10.1016/j.lungcan.2018.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/15/2018] [Accepted: 02/13/2018] [Indexed: 12/20/2022]
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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Affiliation(s)
- F Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain; Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
| | - N Rodriguez de Dios
- Department of Radiation Oncology, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - S Montemuiño
- Department of Radiation Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - J Jové-Teixidó
- Department of Radiation Oncology, Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain.
| | - M Martin
- Department of Radiation Oncology, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo Km9, Madrid, Spain.
| | - P Calvo-Crespo
- Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Choupana s/n, bloque d. Santiago de Compostela, A Coruña, Spain.
| | - M López-Mata
- Department of Radiation Oncology, Hospital Clinico Universitario Lozano Blesa, San Juan Bosco 15, Zaragoza, Spain.
| | - M P Samper-Ots
- Department of Radiation Oncology, Hospital Universitario Rey Juan Carlos, C/Gladiolo s/n. Móstoles, Madrid, Spain.
| | - J L López-Guerra
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, S/N, 41013 Sevilla, Spain.
| | - T García-Cañibano
- Department of Radiation Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - V Díaz-Díaz
- Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cadiz, Spain.
| | - L de Ingunza-Barón
- Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cadiz, Spain.
| | - M Murcia-Mejía
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Av. del Dr. Josep Laporte, 2, 43204 Reus, Tarragona, Spain.
| | - P Alcántara
- Department of Radiation Oncology. Hospital Universitario Clínico San Carlos, C/Prof. Martín Lagos s/n, Madrid, Spain.
| | - J Corona
- Department of Radiation Oncology. Hospital Universitario Clínico San Carlos, C/Prof. Martín Lagos s/n, Madrid, Spain.
| | - M M Puertas
- Department of Radiation Oncology, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain.
| | - M Chust
- Department of Radiation Oncology, Instituto Valenciano de Oncologia, Carrer del Professor Beltrán Báguena, 8, 46009, Valencia, Spain.
| | - M L Couselo
- Department of Radiation Oncology, Hospital Central de la Defensa Gomez Ulla, Glorieta Ejército, 1, 28047, Madrid, Spain.
| | - E Del Cerro
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain; Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
| | - J Moradiellos
- Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - S Amor
- Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - A Varela
- Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - I J Thuissard
- School of Doctoral Studies & Research, Universidad Europea, Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain.
| | - D Sanz-Rosa
- School of Doctoral Studies & Research, Universidad Europea, Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain.
| | - B Taboada
- Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Choupana s/n, bloque d. Santiago de Compostela, A Coruña, Spain.
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Nieder C, Pawinski A, Andratschke NH. Combined radio- and chemotherapy for non-small cell lung cancer: systematic review of landmark studies based on acquired citations. Front Oncol 2013; 3:176. [PMID: 23847765 PMCID: PMC3705186 DOI: 10.3389/fonc.2013.00176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/21/2013] [Indexed: 12/25/2022] Open
Abstract
The important role of combined chemoradiation for several groups of patients with non-small cell lung cancer (NSCLC) is reflected by the large number of scientific articles published during the last 30 years. Different measures of impact and clinical relevance of published research are available, each with its own pros and cons. For this review, article citation rate was chosen. Highly cited articles were identified through systematic search of the citation database Scopus. Among the 100 most often cited articles, meta-analyses (n = 5) achieved a median of 203 citations, guidelines (n = 7) 97, phase III trials (n = 29) 168, phase II trials (n = 21) 135, phase I trials (n = 7) 88, and others combined 115.5 (p = 0.001). Numerous national and international cooperative groups and several single institutions were actively involved in performing often cited, high-impact trials, reflecting the fact that NSCLC is a world-wide challenge that requires research collaboration. Platinum-containing combinations have evolved into a standard of care, typically administered concurrently. The issue of radiotherapy fractionation and total dose has also been studied extensively, yet with less conclusive results. Differences in target volume definition have been addressed. However, it was not possible to test all theoretically possible combinations of radiotherapy regimens, drugs, and drug doses (lower radiosensitizing doses compared to higher systemically active doses). That is why current guidelines offer physicians a choice of different, presumably equivalent treatment alternatives. This review identifies open questions and strategies for further research.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital , Bodø , Norway ; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø , Tromsø , Norway
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