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Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer.

Publication ,  Journal Article
Higgins, KA; Chino, JP; Ready, N; Onaitis, MW; Berry, MF; D'Amico, TA; Kelsey, CR
Published in: J Thorac Cardiovasc Surg
November 2011

OBJECTIVES: Patients achieving a mediastinal pathologic complete response with neoadjuvant chemotherapy have improved outcomes compared with patients with persistent N2 disease. How to best manage this latter group of patients is unknown, prompting a review of our institutional experience. METHODS: All patients who initiated neoadjuvant therapy for non-small-cell lung cancer from 1995 to 2008 were evaluated. The patients were excluded if they had received preoperative radiotherapy, had had a mediastinal pathologic complete response, or had evidence of disease progression after neoadjuvant chemotherapy. The clinical endpoints were calculated using the Kaplan-Meier product-limit method and compared using a log-rank test. RESULTS: A total of 28 patients were identified. The median follow-up period was 24 months. Several neoadjuvant chemotherapy regimens were used, most commonly carboplatin with vinorelbine (36%) or paclitaxel (32%). A partial response to chemotherapy was noted in 23 (82%) and stable disease was noted in 5 (18%) on postchemotherapy imaging. Resection was performed in 22 of 28 patients, consisting of lobectomy in 14, pneumonectomy in 2, and wedge/segmentectomy in 6 (21/22 R0, 1/22 R1). There were no postoperative deaths. Postoperative therapy (radiotherapy and/or additional chemotherapy) was administered to 12 patients (55%). The remaining 6 patients generally received definitive radiotherapy with or without additional chemotherapy. The overall and disease-free survival rate at 1, 3, and 5 years was 75%, 37%, and 37% and 50%, 23%, and 19%, respectively. The survival rate at 5 years was similar between patients undergoing resection (34%) and those receiving definitive radiotherapy with or without chemotherapy (40%; P = .73). CONCLUSIONS: Disease-free and overall survival was sufficiently high to warrant aggressive local therapy (surgery or radiotherapy) in patients with persistent N2 disease after neoadjuvant chemotherapy.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

November 2011

Volume

142

Issue

5

Start / End Page

1175 / 1179

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Radiotherapy, Adjuvant
  • Pulmonary Surgical Procedures
  • North Carolina
 

Citation

APA
Chicago
ICMJE
MLA
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Higgins, K. A., Chino, J. P., Ready, N., Onaitis, M. W., Berry, M. F., D’Amico, T. A., & Kelsey, C. R. (2011). Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer. J Thorac Cardiovasc Surg, 142(5), 1175–1179. https://doi.org/10.1016/j.jtcvs.2011.07.059
Higgins, Kristin A., Junzo P. Chino, Neal Ready, Mark W. Onaitis, Mark F. Berry, Thomas A. D’Amico, and Chris R. Kelsey. “Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer.J Thorac Cardiovasc Surg 142, no. 5 (November 2011): 1175–79. https://doi.org/10.1016/j.jtcvs.2011.07.059.
Higgins KA, Chino JP, Ready N, Onaitis MW, Berry MF, D’Amico TA, et al. Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2011 Nov;142(5):1175–9.
Higgins, Kristin A., et al. “Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer.J Thorac Cardiovasc Surg, vol. 142, no. 5, Nov. 2011, pp. 1175–79. Pubmed, doi:10.1016/j.jtcvs.2011.07.059.
Higgins KA, Chino JP, Ready N, Onaitis MW, Berry MF, D’Amico TA, Kelsey CR. Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2011 Nov;142(5):1175–1179.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

November 2011

Volume

142

Issue

5

Start / End Page

1175 / 1179

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Radiotherapy, Adjuvant
  • Pulmonary Surgical Procedures
  • North Carolina