Induction therapy followed by surgery for T3-T4/N0 non-small cell lung cancer: Long-term results

Filippo Lococo, Alfredo Cesario, Stefano Margaritora, Valentina Dall'Armi, Dania Nachira, Giacomo Cusumano, Elisa Meacci, Pierluigi Granone

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Abstract

Background: The aim of this study was to analyze the impact of the induction chemoradiotherapy (IT) on the survival pattern in T3/T4-N0 non-small cell lung cancer (NSCLC) patients. Methods: The data of 71 patients treated from January 1992 to May 2007 were reviewed. Of these, 31 patients received IT prior to surgery (IT group: T3, 20 patients; and T4, 11 patients), and 40 directly underwent surgery (S group: T3, 34 patients; and T4, 6 patients). Survival rates were compared using the Kaplan-Meier analysis and the Cox proportional hazards models. Results: Mean ages were 62.5 ± 9.9 years in the IT group and 67.7 ± 7.1 in the S group. All patients but 1 completed the IT treatment and 27 patients (87%) were operated. A radical resection was possible in 21 patients (78%). In the IT group a complete pathologic response was obtained in 6 patients (22%), where 8 patients ended up in pI stage, 7 in pII stage, and 6 in pIII stage. The overall 5-year survival (long-term survival [LTS]) and disease-free 5-year survival (DFS) for the entire cohort were 40% and 34%, respectively. No significant differences were found when LTS in the IT group (44%) and in the S group (37%) were compared. At multivariate analysis, the completeness of resection was the only independent predictive factor (hazard ratio [HR] = 5.18; 95% confidence interval [CI] = 2.55 to 10.28) while Cox multivariate analysis (on the IT group only) confirmed the critical role of the pathologic downstaging (HR = 4.62; 95% CI = 1.54 to 13.89). Conclusions: A multimodal strategy with IT treatment followed by surgery is a safe and reasonable treatment in T3/T4-N0 NSCLC patients, but no clear evidence of prognostic improvement may be assumed at the present time. Nevertheless, patients with radical resection and complete pathologic response have a very rewarding survival.

Original languageEnglish
Pages (from-to)1633-1640
Number of pages8
JournalAnnals of Thoracic Surgery
Volume93
Issue number5
DOIs
Publication statusPublished - May 2012

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Non-Small Cell Lung Carcinoma
Chemoradiotherapy
Therapeutics
Survival
Multivariate Analysis
Confidence Intervals
Kaplan-Meier Estimate
Proportional Hazards Models
Disease-Free Survival
Survival Rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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Induction therapy followed by surgery for T3-T4/N0 non-small cell lung cancer : Long-term results. / Lococo, Filippo; Cesario, Alfredo; Margaritora, Stefano; Dall'Armi, Valentina; Nachira, Dania; Cusumano, Giacomo; Meacci, Elisa; Granone, Pierluigi.

In: Annals of Thoracic Surgery, Vol. 93, No. 5, 05.2012, p. 1633-1640.

Research output: Contribution to journalArticle

Lococo, Filippo ; Cesario, Alfredo ; Margaritora, Stefano ; Dall'Armi, Valentina ; Nachira, Dania ; Cusumano, Giacomo ; Meacci, Elisa ; Granone, Pierluigi. / Induction therapy followed by surgery for T3-T4/N0 non-small cell lung cancer : Long-term results. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 5. pp. 1633-1640.
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abstract = "Background: The aim of this study was to analyze the impact of the induction chemoradiotherapy (IT) on the survival pattern in T3/T4-N0 non-small cell lung cancer (NSCLC) patients. Methods: The data of 71 patients treated from January 1992 to May 2007 were reviewed. Of these, 31 patients received IT prior to surgery (IT group: T3, 20 patients; and T4, 11 patients), and 40 directly underwent surgery (S group: T3, 34 patients; and T4, 6 patients). Survival rates were compared using the Kaplan-Meier analysis and the Cox proportional hazards models. Results: Mean ages were 62.5 ± 9.9 years in the IT group and 67.7 ± 7.1 in the S group. All patients but 1 completed the IT treatment and 27 patients (87{\%}) were operated. A radical resection was possible in 21 patients (78{\%}). In the IT group a complete pathologic response was obtained in 6 patients (22{\%}), where 8 patients ended up in pI stage, 7 in pII stage, and 6 in pIII stage. The overall 5-year survival (long-term survival [LTS]) and disease-free 5-year survival (DFS) for the entire cohort were 40{\%} and 34{\%}, respectively. No significant differences were found when LTS in the IT group (44{\%}) and in the S group (37{\%}) were compared. At multivariate analysis, the completeness of resection was the only independent predictive factor (hazard ratio [HR] = 5.18; 95{\%} confidence interval [CI] = 2.55 to 10.28) while Cox multivariate analysis (on the IT group only) confirmed the critical role of the pathologic downstaging (HR = 4.62; 95{\%} CI = 1.54 to 13.89). Conclusions: A multimodal strategy with IT treatment followed by surgery is a safe and reasonable treatment in T3/T4-N0 NSCLC patients, but no clear evidence of prognostic improvement may be assumed at the present time. Nevertheless, patients with radical resection and complete pathologic response have a very rewarding survival.",
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T1 - Induction therapy followed by surgery for T3-T4/N0 non-small cell lung cancer

T2 - Long-term results

AU - Lococo, Filippo

AU - Cesario, Alfredo

AU - Margaritora, Stefano

AU - Dall'Armi, Valentina

AU - Nachira, Dania

AU - Cusumano, Giacomo

AU - Meacci, Elisa

AU - Granone, Pierluigi

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N2 - Background: The aim of this study was to analyze the impact of the induction chemoradiotherapy (IT) on the survival pattern in T3/T4-N0 non-small cell lung cancer (NSCLC) patients. Methods: The data of 71 patients treated from January 1992 to May 2007 were reviewed. Of these, 31 patients received IT prior to surgery (IT group: T3, 20 patients; and T4, 11 patients), and 40 directly underwent surgery (S group: T3, 34 patients; and T4, 6 patients). Survival rates were compared using the Kaplan-Meier analysis and the Cox proportional hazards models. Results: Mean ages were 62.5 ± 9.9 years in the IT group and 67.7 ± 7.1 in the S group. All patients but 1 completed the IT treatment and 27 patients (87%) were operated. A radical resection was possible in 21 patients (78%). In the IT group a complete pathologic response was obtained in 6 patients (22%), where 8 patients ended up in pI stage, 7 in pII stage, and 6 in pIII stage. The overall 5-year survival (long-term survival [LTS]) and disease-free 5-year survival (DFS) for the entire cohort were 40% and 34%, respectively. No significant differences were found when LTS in the IT group (44%) and in the S group (37%) were compared. At multivariate analysis, the completeness of resection was the only independent predictive factor (hazard ratio [HR] = 5.18; 95% confidence interval [CI] = 2.55 to 10.28) while Cox multivariate analysis (on the IT group only) confirmed the critical role of the pathologic downstaging (HR = 4.62; 95% CI = 1.54 to 13.89). Conclusions: A multimodal strategy with IT treatment followed by surgery is a safe and reasonable treatment in T3/T4-N0 NSCLC patients, but no clear evidence of prognostic improvement may be assumed at the present time. Nevertheless, patients with radical resection and complete pathologic response have a very rewarding survival.

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