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Shinohara S, Takahashi Y, Masago K, Matsushita H, Kuroda H. The beginning of a new era in induction treatment for operable non-small cell lung cancer: a narrative review. J Thorac Dis 2023; 15:747-758. [PMID: 36910085 PMCID: PMC9992625 DOI: 10.21037/jtd-22-957] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/25/2022] [Indexed: 02/05/2023]
Abstract
Background and Objective The survival benefit of induction therapy for non-small cell lung cancer (NSCLC) remains controversial. Recently, the outcomes of systemic therapy for NSCLC have dramatically changed with the advent of molecular target drugs and immune checkpoint inhibitors (ICIs). The present review was conducted to investigate the outcomes of induction therapy with reference to randomized control trials (RCTs). Methods We reviewed RCTs and ongoing clinical trials between 1990 and 2022 using relevant databases: PubMed, Web of Science, and EMBASE database. We investigated the outcomes of induction therapy. Key Content and Findings Induction therapy was associated with longer overall survival in comparison to surgery alone in several RCTs for stage III disease. However, its benefit in early-stage (I-II) disease was unclear. Regarding induction chemotherapy and chemoradiotherapy, the safety and survival outcomes did not differ between the two arms. Epidermoid growth factor receptor (EGFR) tyrosine kinase inhibitors as induction therapy in patients with proven EGFR mutations may be a sufficient choice for the improvement of overall survival. In ongoing single arm clinical trials and a randomized control study, the administration of ICIs as induction therapy was associated with a good pathological response and satisfactory safety, which will lead to a better survival outcome. Long-term observation is needed to evaluate the toxicity and survival impact of induction therapy with ICIs. Conclusions Induction chemotherapy and EGFR-TKIs for stage IIIA NSCLC may contribute to the improvement of survival outcomes although the effect of systemic therapy on stage I-II remains controversial. ICIs may be considered as a valuable treatment option because of their feasibility and safety for induction therapy.
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Affiliation(s)
- Shuichi Shinohara
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
- Division of Oncoimmunology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Katsuhiro Masago
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Hirokazu Matsushita
- Division of Oncoimmunology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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2
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Kim HE, Yu WS, Lee CY, Lee JG, Kim DJ, Park SY. Risk factors for pulmonary complications after neoadjuvant chemoradiotherapy followed by surgery for non-small cell lung cancer. Thorac Cancer 2021; 13:361-368. [PMID: 34905807 PMCID: PMC8807251 DOI: 10.1111/1759-7714.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background We aimed to investigate the characteristics and pretreatment risk factors for postoperative pulmonary complications (PPCs) after neoadjuvant concurrent chemoradiotherapy (CRTx) in patients with non‐small cell lung cancer (NSCLC). Methods We retrospectively reviewed data of 122 patients who underwent curative resection after neoadjuvant CRTx for NSCLC between 2007 and December 2019. Clinical data, including pulmonary function and body mass index (BMI) at the time of concurrent CRTx initiation, were analyzed. We performed logistic regression analyses to identify the risk factors for PPCs and built a nomogram with significant factors. Results Of the 122 patients included (mean age, 60.1 ± 9.7 years; 69.7% male), 27 experienced PPCs (severity grade ≥ 2). The most common PPCs were pneumonia (n = 17). Patients with PPCs had a significantly longer hospital stay (median 6.0 vs. 17 days, p < 0.001) and a higher in‐hospital mortality rate (1.1% vs. 29.6%, p < 0.001). In multivariable analysis, lower BMI (odds ratio [OR] 0.796, 95% confidence interval [CI] 0.628–0.987, p = 0.038), no comorbidity (OR 0.220, 95% CI: 0.059–0.819, p = 0.048), smoking history (OR 4.362, 95% CI: 1.210–15.720, p = 0.024), and %predicted DLCO <60% (OR 3.727, 95% CI: 1.319–10.530, p = 0.013) were independent risk factors for PPCs. The predictive accuracy of the nomogram built with factors was excellent (concordance index: 0.756). Conclusions The nomogram constructed with factors identified in multivariable analysis could serve as a reliable tool for evaluating the risk of PPCs in the patients who underwent neoadjuvant CRTx for NSCLC.
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Affiliation(s)
- Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Sik Yu
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Muñoz-Guglielmetti D, Sanchez-Lorente D, Reyes R, Martinez D, Lucena C, Boada M, Paredes P, Parera-Roig M, Vollmer I, Mases J, Martin-Deleon R, Castillo S, Benegas M, Muñoz S, Mayoral M, Cases C, Mollà M, Casas F. Pathological response to neoadjuvant therapy with chemotherapy vs chemoradiotherapy in stage III NSCLC-contribution of IASLC recommendations. World J Clin Oncol 2021; 12:1047-1063. [PMID: 34909399 PMCID: PMC8641007 DOI: 10.5306/wjco.v12.i11.1047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neoadjuvant treatment (NT) with chemotherapy (Ch) is a standard option for resectable stage III (N2) NSCLC. Several studies have suggested benefits with the addition of radiotherapy (RT) to NT Ch. The International Association for the Study of Lung Cancer (IASLC) published recommendations for the pathological response (PHR) of NSCLC resection specimens after NT.
AIM To contribute to the IASLC recommendations showing our results of PHR to NT Ch vs NT chemoradiotherapy (ChRT).
METHODS We analyzed 67 consecutive patients with resectable stage III NSCLC with positive mediastinal nodes treated with surgery after NT Ch or NT ChRT between 2013 and 2020. After NT, all patients were evaluated for radiological response (RR) according to Response Evaluation Criteria in Solid Tumours criteria and evaluated for surgery by a specialized group of thoracic surgeons. All histological samples were examined by the same two pathologists. PHR was evaluated by the percentage of viable cells in the tumor and the resected lymph nodes.
RESULTS Forty patients underwent NT ChRT and 27 NT Ch. Fifty-six (83.6%) patients underwent surgery (35 ChRT and 21 Ch). The median time from ChRT to surgery was 6 wk (3-19) and 8 wk (3-21) for Ch patients. We observed significant differences in RR, with disease progression in 2.5% and 14.8% of patients with ChRT and Ch, respectively, and partial response in 62.5% ChRT vs 29.6% Ch (P = 0.025). In PHR we observed ≤ 10% viable cells in the tumor in 19 (54.4%) and 2 cases (9.5%), and in the resected lymph nodes (RLN) 30 (85.7%) and 7 (33.3%) in ChRT and Ch, respectively (P = 0.001). Downstaging was greater in the ChRT compared to the Ch group (80% vs 33.3%; P = 0.002). In the univariate analysis, NT ChRT had a significant impact on partial RR [odds ratio (OR) 12.5; 95% confidence interval (CI): 1.21 - 128.61; P = 0.034], a decreased risk of persistence of cancer cells in the tumor and RLN and an 87.5% increased probability for achieving downstaging (OR 8; 95%CI: 2.34-27.32; P = 0.001).
CONCLUSION We found significant benefits in RR and PHR by adding RT to Ch as NT. A longer follow-up is necessary to assess the impact on clinical outcomes.
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Affiliation(s)
| | - David Sanchez-Lorente
- Thoracic Surgery Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Roxana Reyes
- Medical Oncology Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Daniel Martinez
- Pathology Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Carmen Lucena
- Pneumology Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Marc Boada
- Thoracic Surgery Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Pilar Paredes
- Nuclear Medicine Department, Faculty of Medicine of University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Cataluña, Spain
| | - Marta Parera-Roig
- Medical Oncology Department, Hospital Comarcal de Vic, Vic 08500, Cataluña, Spain
| | - Ivan Vollmer
- Radiology Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Joel Mases
- Radiation Oncology Department, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Roberto Martin-Deleon
- Pneumology Department, Hospital Universitario Reina Sofia, Córdoba 14004, Andalucía, Spain
| | - Sergi Castillo
- Medical Oncology Department, Hospital de Mollet, Mollet 08100, Cataluña, Spain
| | - Mariana Benegas
- Radiology Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Silvia Muñoz
- Medical Oncology Department, Hospital General de Granollers, Granollers 08402, Cataluña, Spain
| | - Maria Mayoral
- Nuclear Medicine Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Carla Cases
- Radiation Oncology Department, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Meritxell Mollà
- Radiation Oncology Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
| | - Francesc Casas
- Radiation Oncology Department, Thoracic Unit, Hospital Clínic de Barcelona, Barcelona 08036, Cataluña, Spain
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Mielgo-Rubio X, Montemuiño S, Jiménez U, Luna J, Cardeña A, Mezquita L, Martín M, Couñago F. Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of Immunotherapy. Cancers (Basel) 2021; 13:cancers13194811. [PMID: 34638296 PMCID: PMC8507745 DOI: 10.3390/cancers13194811] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary The treatment of resectable stage III non-small-cell lung cancer with N2 lymph node involvement is usually multimodal and is generally based on neoadjuvant chemotherapy +/− radiotherapy followed by surgery, but the cure rate is still low. Immunotherapy based on anti-PD1/PD-L1 immune checkpoint inhibitors has improved survival in advanced and stage III non-resectable NSCLC patients and is being studied in earlier stages to improve the cure rate of lung cancer. In this article, we review all therapeutic approaches to stage III-N2 NSCLC, analysing both completed and ongoing studies that evaluate the addition of immunotherapy with or without chemotherapy and/or radiotherapy. Abstract Stage III non-small-cell lung cancer (NSCLC) with N2 lymph node involvement is a heterogeneous group with different potential therapeutic approaches. Patients with potentially resectable III-N2 NSCLC are those who are considered to be able to receive a multimodality treatment that includes tumour resection after neoadjuvant therapy. Current treatment for these patients is based on neoadjuvant chemotherapy +/− radiotherapy followed by surgery and subsequent assessment for adjuvant chemotherapy and/or radiotherapy. In addition, some selected III-N2 patients could receive upfront surgery or pathologic N2 incidental involvement can be found a posteriori during analysis of the surgical specimen. The standard treatment for these patients is adjuvant chemotherapy and evaluation for complementary radiotherapy. Despite being a locally advanced stage, the cure rate for these patients continues to be low, with a broad improvement margin. The most immediate hope for improving survival data and curing these patients relies on integrating immunotherapy into perioperative treatment. Immunotherapy based on anti-PD1/PD-L1 immune checkpoint inhibitors is already a standard treatment in stage III unresectable and advanced NSCLC. Data from the first phase II studies in monotherapy neoadjuvant therapy and, in particular, in combination with chemotherapy, are highly promising, with impressive improved and complete pathological response rates. Despite the lack of confirmatory data from phase III trials and long-term survival data, and in spite of various unresolved questions, immunotherapy will soon be incorporated into the armamentarium for treating stage III-N2 NSCLC. In this article, we review all therapeutic approaches to stage III-N2 NSCLC, analysing both completed and ongoing studies that evaluate the addition of immunotherapy with or without chemotherapy and/or radiotherapy.
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Affiliation(s)
- Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain;
- Correspondence:
| | - Sara Montemuiño
- Department of Radiation Oncology, Hospital Universitario Fuenlabrada, 28942 Madrid, Spain;
| | - Unai Jiménez
- Department of Thoracic Surgery, Hospital Universitario Cruces, 48903 Barakaldo, Bizkaia, Spain;
| | - Javier Luna
- Department of Radiation Oncology, Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Ana Cardeña
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain;
| | - Laura Mezquita
- Department of Medical Oncology, Hospital Universitari Clínic Barcelona, 08036 Barcelona, Spain;
| | - Margarita Martín
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain;
- Department of Radiation Oncology, Hospital La Luz, 28003 Madrid, Spain
- Medicine Department, School of Biomedical Siciences, Universidad Europea, 28670 Madrid, Spain
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Montemuiño Muñiz S, Marcos Sánchez S, Calzas Rodríguez J, Losada Vila B, Llorente Herrero E, Hisado Díaz MD, Valeri-Busto González V, Taboada Valladares B, Vaquero Barrón B, Marcos Jimenez FJ, Amor Alonso S, Moradiellos J, Rodríguez de Dios N, Couñago F. Advances in multimodal treatment for stage IIIA-N2 non-small cell lung cancer. J Clin Transl Res 2021; 7:185-198. [PMID: 34104821 PMCID: PMC8177852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/09/2020] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND AIM In Stage IIIA-N2 non-small cell lung cancer (NSCLC), the accuracy of combined positron-emission tomography/computed tomography imaging (PET-CT), together with mediastinal staging techniques, has led to a wide range of challenging clinical scenarios in terms of therapeutic management. Concurrent chemoradiotherapy followed by consolidation immunotherapy remains the standard of care. In patients with potentially-resectable disease, surgery plays an important role in multimodal therapy. The introduction of targeted therapies and immune-checkpoint inhibitors has revolutionized multimodal treatment. In the present article, we review current treatment options and future trends in stage IIIA-N2 NSCLC. RELEVANCE FOR PATIENTS This article provides insight into the current status of multimodal treatment for NSCLC to support decision-making in routine clinical practice.
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Affiliation(s)
- Sara Montemuiño Muñiz
- Department of Radiation Oncology, Hospital Universitario de
Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Sara
Montemuiño, Spain
| | - Soraya Marcos Sánchez
- Department of Radiation Oncology, Hospital Universitario de
Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Sara
Montemuiño, Spain
| | - Julia Calzas Rodríguez
- Department of Medical Oncology, Hospital Universitario de
Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain
| | - Beatriz Losada Vila
- Department of Medical Oncology, Hospital Universitario de
Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain
| | - Esther Llorente Herrero
- Department of Nuclear Medicine, Hospital Universitario de
Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain
| | - María Dolores Hisado Díaz
- Department of Pulmonology, Hospital Universitario de
Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain
| | - Victoria Valeri-Busto González
- Department of Pulmonology, Hospital Universitario de
Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain
| | - Begoña Taboada Valladares
- Department of Radiation Oncology, Complexo Hospitalario
Universitario Santiago de Compostela, Choupana s/n, bloque d, Santiago de
Compostela, A Coruña, Spain
| | - Blanca Vaquero Barrón
- Department of Radiation Oncology, Hospital Universitario de
La Princesa, C/Diego de León, 62, 28006, Madrid, Spain
| | - Francisco José Marcos Jimenez
- Department of Radiation Oncology, Hospital Universitario de
Cáceres, Avda, Universidad 75, 10004, Cáceres, Extremadura,
Spain
| | - Sergio Amor Alonso
- Department of Thoracic Surgery, Hospital Universitario
Quirónsalud Madrid, C/Diego de Velázquez, 1, 28223, Pozuelo de
Alarcón, Madrid, Spain
| | - Javier Moradiellos
- Department of Thoracic Surgery, Hospital Universitario
Quirónsalud Madrid, C/Diego de Velázquez, 1, 28223, Pozuelo de
Alarcón, Madrid, Spain
| | - Núria Rodríguez 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
- Pompeu Fabra University, Barcelona, Doctor Aiguader, 80,
08003 Barcelona
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario
Quirónsalud Madrid, C/Diego de Velázquez, 1, 28223, Pozuelo de
Alarcón, Madrid, Spain
- Hospital La Luz, Calle del Maestro Ángel Llorca 8,
28003, Madrid, Spain
- Universidad Europea de Madrid, Calle Tajo, s/n, 28670
Villaviciosa de Odón, Madrid, Spain
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[Perioperative treatment for resected non-small cell lung cancer: Which option in 2020?]. Rev Mal Respir 2021; 38:74-86. [PMID: 33402250 DOI: 10.1016/j.rmr.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022]
Abstract
Surgery is the ultimate curative treatment for resectable non-small cell lung cancer (NSCLC). However, the prognosis for operated patients remains disappointing. Multiple randomized studies have shown that administering perioperative chemotherapy improves the prognosis and increases the cure rate by around 3-5%. The purpose of this article is to take stock of the role of perioperative treatments for NSCLC, which can be completely resected. Six questions were evaluated: 1) What is the place of (neo) adjuvant chemotherapy in 2020, among others in the early stages (IB)? 2) Can new chemotherapy agents be combined with a platinum derivative? 3) What is the place of radiochemotherapy for resectable NSCLC? 4) Is there a place for postoperative radiotherapy (PORT)? 5) Is there a place for targeted therapies for resectable NSCLC? 6) What is the place of immunotherapies in the perioperative period?
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7
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Post-Operative Morbidity and Mortality Following Total Neoadjuvant Therapy Versus Conventional Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer. J Gastrointest Cancer 2020; 52:976-982. [PMID: 32936391 DOI: 10.1007/s12029-020-00401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Standard of care for locally advanced rectal cancer (LARC) (stage II/III) includes preoperative chemoradiation (CRT) followed by resection and adjuvant chemotherapy. Total neoadjuvant therapy (TNT) is a new treatment paradigm that delivers systemic therapy prior to CRT aimed at improving outcomes for high-risk patients. Here we analyzed the national cancer database (NCDB) comparing short-term post-operative outcomes between patients receiving TNT and CRT. METHODS The NCDB was queried to identify patients with LARC between the 2004 and 2014 treated with TNT or CRT. Primary outcomes included post-operative 30-day mortality and readmissions between TNT and CRT which were analyzed via logistic regression. Secondary outcomes included post-operative length of stay (LOS) and OS which were compared with two-tailed t-test and Kaplan-Meier with log rank testing, respectively. RESULTS A total of 9066 patients met inclusion criteria with a median age at diagnosis that was 57 years (IQR, 19-65); 62.3% were male and 87.8% white. Neoadjuvant therapy consisted of either standard CRT (97.2%) or TNT (2.8%). Patients treated at academic programs and those with N1 [p < 0.001, OR 2.34, 95%CI 1.71-3.19] or N2 [p < 0.001, OR 3.29, 95%CI 2.19-4.94] disease were associated with increased utilization of TNT. TNT was not significantly associated with either 30-day mortality (p = 1.0) or readmissions (p = 0.82). Further, there was no significant difference identified between CRT and TNT for hospital LOS or OS (p = 0.18). CONCLUSION This large-scale analysis of patients with LARC demonstrates increased utilization of TNT in patients harboring node-positive disease. Further, TNT does not appear to increase 30-day post-operative mortality, readmissions, or hospital LOS.
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Joosten PJM, Damhuis RAM, van Diessen JNA, de Langen JA, Belderbos JSA, Smit EF, Klomp HM, Veenhof AAFA, Hartemink KJ. Results of neoadjuvant chemo(radio)therapy and resection for stage IIIA non-small cell lung cancer in The Netherlands. Acta Oncol 2020; 59:748-752. [PMID: 32347142 DOI: 10.1080/0284186x.2020.1757150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Concurrent chemoradiotherapy remains the main treatment strategy for patients with stage IIIA non-small cell lung cancer (NSCLC); stage cT3N1 or cT4N0-1 may be eligible for surgery and potentially resectable stage IIIA (N2) NSCLC for neoadjuvant therapy followed by resection. We evaluated treatment patterns and outcomes of patients with stage IIIA NSCLC in The Netherlands.Material and Methods: Primary treatment data of patients with clinically staged IIIA NSCLC between 2010 and 2016 were extracted from The Netherlands Cancer Registry. Patient characteristics were tabulated and 5-year overall survival (OS) was calculated and reported.Results: In total, 9,591 patients were diagnosed with stage IIIA NSCLC. Of these patients, 41.3% were treated with chemoradiotherapy, 11.6% by upfront surgery and 428 patients (4.5%) received neoadjuvant treatment followed by resection. The 5-year OS was 26% after chemoradiotherapy, 40% after upfront surgery and 54% after neoadjuvant treatment followed by resection. Clinical over staging was seen in 42.3% of the patients that were operated without neoadjuvant therapy.Conclusion: In The Netherlands, between 2010 and 2016, 4.5% of patients with stage IIIA NSCLC were selected for treatment with neoadjuvant therapy followed by resection. The 5-year OS in these patients exceeded 50%. However, the outcome might be overestimated due to clinical over staging.
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Affiliation(s)
- Pieter J. M. Joosten
- Department of Surgery, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ronald A. M. Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Judi N. A. van Diessen
- Department of Radiation Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Joop A. de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jose S. A. Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Egbert F. Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Houke M. Klomp
- Department of Surgery, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Alexander A. F. A. Veenhof
- Department of Surgery, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Koen J. Hartemink
- Department of Surgery, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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