Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society)

作者：Counago F^*; Rodriguez de Dios N; Montemuino S; Jove Teixido J; Martin M; Calvo Crespo P; Lopez Mata M; Samper Ots M P; Lopez Guerra J L; Garcia Canibano T; Diaz Diaz V; de Ingunza Baron L; Murcia Mejia M; Alcantara P; Corona J; Puertas M M; Chust M; Couselo M L; del Cerro E; Moradiellos J; Amor S; Varela A; Thuissard I J; Sanz Rosa D; Taboada B

来源：Lung Cancer, 2018, 118: 119-127.

DOI：10.1016/j.lungcan.2018.02.008

• NSCLC
• stage IIIA
• Neoadjuvant treatment
• Chemoradiation
• Surgery

Objectives: The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT).
Material and methods: 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 were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group).
Results: Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, 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 significantly higher in the CRTS group. This survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup versus 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.
Conclusion: The findings reported here indicate that neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy) yields better OS and PFS than definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC.

• 出版日期2018-4