NEOADJUVANT TREATMENT FOLLOWED BY SURGERY BETTER THAN DEFINITE CHEMORADIOTHERAPY FOR IIIA-N2 NSCL

Researchers retrospectively compared neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT) for stage IIIA-N2 non-small cell lung cancer (NSCLC). As per findings, better overall survival and progression-free survival can be achieved with neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy), compared with definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC. 

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Methods

• Researchers identified 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.
• They carried out a centralized review to ensure resectability. 
• Also, they performed a propensity score matched analysis to balance patient and tumor characteristics (n = 78 per group).

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Results

• CRTS was the mode of treatment in 118 and dCRT in 129. 
• In the CRTS group, neoadjuvant CRT was given to 62 patients (52.5%) and neoadjuvant chemotherapy to 56 (47.4%). 
• Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). 
• In the CRTS group, significantly higher 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 noted in the matched samples. 
• Researchers noted that survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup vs 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.