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Preoperative chemotherapy versus preoperative chemoradiotherapy for stage III (N2) non-small-cell lung cancer.

Publication ,  Journal Article
Higgins, K; Chino, JP; Marks, LB; Ready, N; D'Amico, TA; Clough, RW; Kelsey, CR
Published in: Int J Radiat Oncol Biol Phys
December 1, 2009

PURPOSE: To compare preoperative chemotherapy (ChT) and preoperative chemoradiotherapy (ChT-RT) in operable Stage III non-small-cell lung cancer. METHODS AND MATERIALS: This retrospective study analyzed all patients with pathologically confirmed Stage III (N2) non-small-cell lung cancer who initiated preoperative ChT or ChT-RT at Duke University between 1995 and 2006. Mediastinal pathologic complete response (pCR) rates were compared using a chi-square test. The actuarial overall survival, disease-free survival, and local control were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was also performed. RESULTS: A total of 101 patients who initiated preoperative therapy with planned resection were identified. The median follow-up was 20 months for all patients and 38 months for survivors. The mediastinal lymph nodes were reassessed after preoperative therapy in 88 patients (87%). Within this group, a mediastinal pCR was achieved in 35% after preoperative ChT vs. 65% after preoperative ChT-RT (p = 0.01). Resection was performed in 69% after ChT and 84% after ChT-RT (p = 0.1). For all patients, the overall survival, disease-free survival, and local control rate at 3 years was 40%, 27%, and 66%, respectively. No statistically significant differences were found in the clinical endpoints between the ChT and ChT-RT subgroups. On multivariate analysis, a mediastinal pCR was associated with improved disease-free survival (p = 0.03) and local control (p = 0.03), but not overall survival (p = 0.86). CONCLUSION: Preoperative ChT-RT was associated with higher mediastinal pCR rates but not improved survival.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

December 1, 2009

Volume

75

Issue

5

Start / End Page

1462 / 1467

Location

United States

Related Subject Headings

  • Survival Analysis
  • Retrospective Studies
  • Remission Induction
  • Regression Analysis
  • Preoperative Period
  • Oncology & Carcinogenesis
  • North Carolina
  • Neoplasm Staging
  • Middle Aged
  • Mediastinum
 

Citation

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Higgins, K., Chino, J. P., Marks, L. B., Ready, N., D’Amico, T. A., Clough, R. W., & Kelsey, C. R. (2009). Preoperative chemotherapy versus preoperative chemoradiotherapy for stage III (N2) non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 75(5), 1462–1467. https://doi.org/10.1016/j.ijrobp.2009.01.069
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

December 1, 2009

Volume

75

Issue

5

Start / End Page

1462 / 1467

Location

United States

Related Subject Headings

  • Survival Analysis
  • Retrospective Studies
  • Remission Induction
  • Regression Analysis
  • Preoperative Period
  • Oncology & Carcinogenesis
  • North Carolina
  • Neoplasm Staging
  • Middle Aged
  • Mediastinum