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Foster CC, Rusthoven CG, Sher DJ, Feldman L, Pasquinelli M, Spiotto MT, Koshy M. Adjuvant chemotherapy following stereotactic body radiotherapy for early stage non-small-cell lung cancer is associated with lower overall: A National Cancer Database Analysis. Lung Cancer 2019; 130:162-168. [PMID: 30885339 DOI: 10.1016/j.lungcan.2019.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/21/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Adjuvant chemotherapy is routinely offered post-surgical resection for early stage non-small-cell lung cancer (NSCLC) ≥4 cm; however, its role following definitive stereotactic body radiotherapy (SBRT) has not been well defined. We investigated the association between receipt of adjuvant chemotherapy post-SBRT and overall survival (OS) for patients with T1-T3N0M0 NSCLC in the National Cancer Database (NCDB). MATERIALS AND METHODS The NCDB was queried for patients with T1-T3N0M0 NSCLC treated with definitive SBRT from 2004 to 2014. The association between non-randomized receipt of adjuvant chemotherapy and OS was analyzed for all patients (n = 24,011) and a propensity-matched cohort (n = 608) using Kaplan-Meier methods and Cox proportional hazard models. A subset analysis was performed for patients with tumors ≥4 cm (n = 2,323). RESULTS There were 24,011 patients in the cohort with a median follow-up of 32.5 months. Of these, 322 (1.3%) received adjuvant chemotherapy. Three-year OS was 41.3% with adjuvant chemotherapy compared to 50.6% without adjuvant chemotherapy (p = 0.001). On multivariate analysis, adjuvant chemotherapy was independently associated with higher overall mortality (hazard ratio:1.22, 95% confidence interval:1.06-1.40, p = 0.005). For tumors ≥4 cm, 3-year OS was 38.2% with adjuvant chemotherapy (n = 80) compared to 33.0% without adjuvant chemotherapy (p = 0.81). After propensity-score matching, there was a persistent association between lower OS and adjuvant chemotherapy with those receiving adjuvant chemotherapy (n = 322) having 3-year OS of 41.3% compared to 60.9% without adjuvant chemotherapy (p < 0.0001). CONCLUSION Adjuvant chemotherapy following definitive SBRT for T1-3N0M0 NSCLC is associated with lower OS and is not associated with a survival benefit for patients with tumors ≥4 cm.
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Affiliation(s)
- Corey C Foster
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Avenue, MC 9006, Chicago, IL, 60637, USA
| | - Chad G Rusthoven
- Department of Radiation Oncology at the Anschutz Medical Campus, University of Colorado School of Medicine, 1655 Aurora Court, Suite 1032, Aurora, CO, 80045, USA
| | - David J Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Radiation Oncology Building, 2280 Inwood Road, Dallas, TX, 75390-9303, USA
| | - Lawrence Feldman
- Department of Medical Oncology, University of Illinois at Chicago, Outpatient Care Center, Suite 1E, 1801 West Taylor Street, Chicago, IL, 60612, USA
| | - Mary Pasquinelli
- Department of Medical Oncology, University of Illinois at Chicago, Outpatient Care Center, Suite 1E, 1801 West Taylor Street, Chicago, IL, 60612, USA
| | - Michael T Spiotto
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Avenue, MC 9006, Chicago, IL, 60637, USA; Department of Radiation Oncology, University of Illinois at Chicago, Outpatient Care Center, 1801 West Taylor Street, Chicago, IL, 60612, USA
| | - Matthew Koshy
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Avenue, MC 9006, Chicago, IL, 60637, USA; Department of Radiation Oncology, University of Illinois at Chicago, Outpatient Care Center, 1801 West Taylor Street, Chicago, IL, 60612, USA.
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Adjuvant Chemotherapy Does Not Improve Survival for Lung Cancer With Chest Wall Invasion. Ann Thorac Surg 2017; 104:1798-1804. [PMID: 29074150 DOI: 10.1016/j.athoracsur.2017.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/10/2017] [Accepted: 06/28/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The National Comprehensive Cancer Network recommends adjuvant chemotherapy (AC) for patients with completely resected (R0) pT3N0M0 non-small cell lung cancer (NSCLC) with chest wall invasion. There is minimal evidence to support this recommendation. We aimed to determine whether there is a survival benefit with AC and if so whether it depends on tumor size. METHODS Patients who had undergone R0 resection for pT3N0M0 NSCLC with chest wall invasion were identified in the National Cancer Data Base from 2008 to 2012. Multivariable Cox proportional hazards modeling was used to determine independent predictors of overall mortality. RESULTS Of 247 patients, 92 (37.3%) received AC. The median tumor size without AC was 42 mm (interquartile range [IQR], 30 to 60 mm) and with AC was 56 mm (IQR, 40 to 70 mm; p = 0.003). Median follow-up was 21.7 months (IQR, 10.6 to 29.1 months). There was no difference in AC based on tumor grade, but the 3-year overall survival for those with well-differentiated or moderately differentiated tumors was 68% versus 55% in those with poorly differentiated or undifferentiated tumors. Three-year overall survival for the entire cohort was 59%. There was no difference in overall survival between those who received AC and those who did not. The only significant predictor of mortality in both univariable and multivariable analyses was poorly or undifferentiated tumor grade. CONCLUSIONS For patients with pT3N0M0 NSCLC with chest wall invasion there is no survival benefit with AC, regardless of tumor size or grade, after R0 resection. Poorly differentiated or undifferentiated tumor grade is an independent predictor of mortality.
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Stereotactic Body Radiation Therapy and the Influence of Chemotherapy on Overall Survival for Large (≥5 Centimeter) Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017; 97:146-154. [DOI: 10.1016/j.ijrobp.2016.09.036] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 02/07/2023]
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Gao SJ, Corso CD, Blasberg JD, Detterbeck FC, Boffa DJ, Decker RH, Kim AW. Role of Adjuvant Therapy for Node-Negative Lung Cancer Invading the Chest Wall. Clin Lung Cancer 2016; 18:169-177.e4. [PMID: 27890561 DOI: 10.1016/j.cllc.2016.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/19/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The present study investigated the effect of adjuvant chemotherapy and radiation on survival among patients undergoing chest wall resection for T3N0 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients with T3N0 NSCLC who underwent chest wall resection were identified in the National Cancer Data Base in 2004 to 2012. The cohort was divided into patients who had received adjuvant chemotherapy, radiation therapy, chemoradiation therapy, or no adjuvant treatment. Kaplan-Meier and log-rank tests were used to compare overall survival, and a bootstrapped Cox proportional hazards model was used to determine the significant contributors to survival. A subset analysis was performed with stratification by margin status and tumor size. RESULTS Of 759 patients identified, 42.0% underwent surgery alone, 23.3% underwent surgery followed by chemotherapy, 22.3% underwent surgery followed by chemoradiation therapy, and 12.3% underwent surgery followed by radiotherapy alone. Tumors > 4 cm benefited from adjuvant chemotherapy and radiation therapy in the multivariable analysis, and those ≤ 4 cm benefited only from adjuvant chemotherapy. The subgroup analysis by margin status identified that margin-positive patients with tumors > 4 cm benefited significantly from either adjuvant chemoradiation therapy or radiation therapy alone. CONCLUSION T3N0 NSCLC with chest wall invasion requires unique management compared with other stage IIB tumors. An important determinant of management is tumor size, with tumors ≤ 4 cm benefiting from adjuvant chemotherapy and tumors > 4 cm benefiting from adjuvant chemotherapy if margin negative and adjuvant chemoradiation therapy or radiotherapy if margin positive.
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Affiliation(s)
- Sarah J Gao
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Christopher D Corso
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Justin D Blasberg
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Frank C Detterbeck
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Daniel J Boffa
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Anthony W Kim
- Department of Surgery, Yale University School of Medicine, New Haven, CT.
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Eriguchi T, Takeda A, Sanuki N, Nishimura S, Takagawa Y, Enomoto T, Saeki N, Yashiro K, Mizuno T, Aoki Y, Oku Y, Yokosuka T, Shigematsu N. Stereotactic body radiotherapy for T3 and T4N0M0 non-small cell lung cancer. JOURNAL OF RADIATION RESEARCH 2016; 57:265-72. [PMID: 26983978 PMCID: PMC4915546 DOI: 10.1093/jrr/rrw023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/20/2016] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
To evaluate the outcomes and feasibility of stereotactic body radiotherapy (SBRT) for cT3 and cT4N0M0 non-small cell lung cancer (NSCLC), 25 patients with localized primary NSCLC diagnosed as cT3 or cT4N0M0, given SBRT between May 2005 and July 2013, were analyzed. All patients had inoperable tumors. The major reasons for tumors being unresectable were insufficient respiratory function for curative resection, advanced age (>80 years old) or technically inoperable due to invasion into critical organs. The median patient age was 79 years (range; 60-86). The median follow-up duration was 25 months (range: 5-100 months). The 2-year overall survival rates for T3 and T4 were 57% and 69%, respectively. The 2-year local control rates for T3 and T4 were 91% and 68%, respectively. As for toxicities, Grade 0-1, Grade 2 and Grade 3 radiation pneumonitis occurred in 23, 1 and 1 patient, respectively. No other acute or symptomatic late toxicities were reported. Thirteen patients who had no local, mediastinal or intrapulmonary progression at one year after SBRT underwent pulmonary function testing. The median variation in pre-SBRT and post-SBRT forced expiratory volume in 1 s (FEV1) values was -0.1 (-0.8-0.8). This variation was not statistically significant (P = 0.56). Forced vital capacity (FVC), vital capacity (VC), %VC and %FEV1 also showed no significant differences. SBRT for cT3 and cT4N0M0 NSCLC was both effective and feasible. Considering the favorable survival and low morbidity rate, SBRT is a potential treatment option for cT3 and cT4N0M0 NSCLC.
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Affiliation(s)
- Takahisa Eriguchi
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan Department of Radiology, Keio University School of Medicine
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Naoko Sanuki
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Shuichi Nishimura
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Yoshiaki Takagawa
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Tatsuji Enomoto
- Department of Respiratory Medicine, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Noriyuki Saeki
- Department of Thoracic Surgery, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Kae Yashiro
- Department of Radiology, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Tomikazu Mizuno
- Department of Radiology, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Yousuke Aoki
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Yohei Oku
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura-shi, Kanagawa 247-0056, Japan
| | - Tetsuya Yokosuka
- Department of Thoracic Surgery, Tokyo Metropolitan Hiroo Hospital
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Lymph Node Ratio May Predict the Benefit of Postoperative Radiotherapy in Non–Small-Cell Lung Cancer. J Thorac Oncol 2013; 8:940-6. [DOI: 10.1097/jto.0b013e318292c53e] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Features and Prognostic Factors of Large Node-Negative Non–Small-Cell Lung Cancers Shifted to Stage II. J Thorac Oncol 2012; 7:1124-30. [DOI: 10.1097/jto.0b013e318252cfd4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee CY, Byun CS, Lee JG, Kim DJ, Cho BC, Chung KY, Park IK. The prognostic factors of resected non-small cell lung cancer with chest wall invasion. World J Surg Oncol 2012; 10:9. [PMID: 22236955 PMCID: PMC3283516 DOI: 10.1186/1477-7819-10-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 01/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We retrospectively reviewed the clinical features and surgical outcomes of patients with a surgically resected NSCLC invading chest wall in order to identify prognostic factors that impact long term survival. METHODS Between January 1990 and December 2009, 107 patients who underwent surgical resection for chest wall invading NSCLC were reviewed. Tumors invading only the parietal pleura were defined as superficial invasions, and those involving the soft tissue or ribs were defined as deep invasions. RESULTS There were 91 men and 16 women; median age was 64 years (range 30 to 80 years). Overall 5 year survival rate was 26.3%. The univariate prognostic factors for survival included gender, extent of resection (pneumonectomy vs lobectomy), tumor size(> 5 cm vs ≤ 5 cm), nodal status (N0 or N1 vs N2), completeness of resection (complete vs incomplete) and completeness of adjuvant chemotherapy. At multivariate analysis, five independent prognostic factors were shown; depth of invasion (superficial vs deep), tumor size, nodal status, completeness of resection, and completeness of adjuvant chemotherapy. In patients with completely resected T3N0 NSCLC, completion of chemotherapy is the only prognostic factor for long term survival. CONCLUSIONS Completeness of resection, nodal status, depth of invasion, tumor size, and adjuvant chemotherapy were prognostic factors for long-term survival in NSCLC patients with chest wall invasion. Because of poor prognosis in cases with chest wall invasion that have N2 positive LN, that is difficult to achieve complete resection and that need pneumonectomy, definite chemoradiotherapy or neoadjuvant chemoradiotherapy should be considered first in these cases.
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Affiliation(s)
- Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea
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Maeda R, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K. Risk Factors for Tumor Recurrence in Patients With Early-Stage (Stage I and II) Non-small Cell Lung Cancer. Chest 2011; 140:1494-1502. [DOI: 10.1378/chest.10-3279] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Suzuki M, Yoshida S, Moriya Y, Hoshino H, Mizobuchi T, Okamoto T, Yoshino I. Single T factors predict survival of patients with resected stage-IIB non-small-cell lung cancers. Eur J Cardiothorac Surg 2011; 39:745-8. [DOI: 10.1016/j.ejcts.2010.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 07/30/2010] [Accepted: 08/05/2010] [Indexed: 11/26/2022] Open
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Adjuvant chemotherapy in new stage II pN0 non-small cell lung cancer: a new issue for a case-by-case decision making process. J Thorac Oncol 2010; 5:754. [PMID: 20421773 DOI: 10.1097/jto.0b013e3181d6bc50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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