A prospective, multi-institutional phase II study of induction chemoradiotherapy followed by surgery in patients with non-small cell lung cancer involving the chest wall (CJLSG0801).

Kawaguchi, Koji; Yokoi, Kohei; Niwa, Hiroshi; Ohde, Yasuhisa; Mori, Satoshi; Okumura, Sakae; Shiono, Satoshi; Ito, Hiroyuki; Yano, Motoki; Shigemitsu, Kikuo; Hiramatsu, Yoshihiro; Okami, Jiro; Sasaki, Hideo

doi:10.1200/jco.2016.34.15_suppl.8525

Cited by 3 publications

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“…For this reason, a prospective multi-institutional study for each patient group is needed to obtain credible data to determine the best treatment strategy for cT3-4 NSCLC. Kawaguchi et al 11 recently reported the results of a prospective multi-institutional study of induction CRT for patients with cT3N0-1 NSCLC having chest wall invasion. They noted a favorable outcome, with a 5-year OS rate of 63%.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Recently, a prospective multi-institutional phase II study of induction CRT followed by surgery for NSCLC with chest wall involvement showed good results. 11 In our institution, induction CRT followed by surgery has been proactively applied for cT3-4 NSCLCs. In the present study, we retrospectively analyzed the short-and long-term outcomes of induction CRT followed by surgery for cT3-4 NSCLC to demonstrate the efficacy of this treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Recently, a prospective multi-institutional phase II study of induction CRT followed by surgery for NSCLC with chest wall involvement showed good results. 11…”

Section: Introductionmentioning

confidence: 99%

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The Outcomes of Induction Chemoradiotherapy Followed by Surgery for Clinical T3-4 Non-Small Cell Lung Cancer

Kanzaki

Ose

Funaki

et al. 2019

Technol Cancer Res Treat

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Purpose: Information on the short- and long-term outcomes of induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer is limited. We analyzed the short- and long-term outcomes of induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer. Methods: Patients with non-small cell lung cancer who underwent induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer were retrospectively reviewed (initial treatment group, n = 31). Their results were compared to those patients who underwent surgery as an initial treatment during the same period (initial surgery group, n = 35). Results: Downstaging was achieved in 14 (45%) patients in the initial treatment group. R0 resection was achieved in 28 (90%) patients in the initial treatment group and 31 (88%) patients in the initial surgery group. The 90-day mortality rate was 3% in each group. Postoperative complications occurred in 16 (52%) patients in the initial treatment group and 13 (37%) patients in the initial surgery group. The 5-year overall survival rate of the initial treatment group was significantly higher than that of the initial surgery group (62.6% vs 43.5%, P = .04). The 5-year overall survival rates of the initial treatment N0-1 group and the initial surgery N0-1 group were 88.9% and 49.3%, respectively; the difference was statistically significant ( P = .02). Multivariate analysis using 4 factors (age [≤65 vs >65], cN [cN0-1 vs cN2], general condition [chemoradiotherapy fit vs chemoradiotherapy unfit], and treatment mode [induction chemoradiotherapy followed by surgery vs surgery as an initial treatment]) revealed that treatment mode (induction chemoradiotherapy followed by surgery) and cN status (cN0-1) were significantly associated with good overall survival and disease-free survival. Conclusions: Induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer could be performed with an acceptable degree of surgical risk. At present, it is thought to be one of the reasonable treatment approaches for selected patients with cT3-4 disease, even those with a cN0-1 status.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Outcomes of Induction Chemoradiotherapy Followed by Surgery for Clinical T3-4 Non-Small Cell Lung Cancer

Kanzaki

Ose

Funaki

et al. 2019

Technol Cancer Res Treat

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“…The Thoracic Surgery Division at Toronto General Hospital reported on a retrospective series of 48 patients with NSCLC invading the superior sulcus or spine using the SWOG 9416 treatment strategy where a pathologic or near pathologic complete response was seen in 50% of patients (17). Employing this paradigm to lung cancers invading the chest wall outside of the superior sulcus was explored by a Japanese Lung Study Group in a phase II trial of chemotherapy (two cycles of cisplatin + vinorelbine) concurrent with radiotherapy (40 Gy) followed by surgery (18). Although the study included some superior sulcus tumors, a pathologic complete response was seen in 13 (26%) patients.…”

Section: Review Articlementioning

confidence: 99%

A narrative review of surgical management of lung cancer involving the chest wall: oncologic results

Lanuti¹

2021

Curr Chall Thorac Surg

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The prevalence of chest wall invasion by non-small cell lung cancer (NSCLC) is <10% in published surgical series; however, its presence can greatly influence surgical management and invoke multimodality therapy. Randomized trials investigating the role of multi-modality therapy for lung cancer with chest wall invasion are few and are primarily limited to the management of superior sulcus tumors. The role of radiation or chemotherapy around the complete resection of lung cancer invading the chest wall, excluding the superior sulcus of the chest, has not been effectively evaluated in a randomized prospective study. Survival of patients with lung cancer invading the chest wall is highly dependent on the extent of lymph node involvement and the completeness of en-bloc resection. When performing chest wall resection, ≥1 cm margin in all directions is generally accepted. Invasive mediastinal staging should be a mandatory part of the metastatic survey of any patient harboring NSCLC with radiographic or clinical chest wall invasion.Surgeons should strive for complete resection and implement reconstruction techniques that are appropriate for chest wall location. Chest wall defects <5 cm can often be managed without reconstruction. In carefully selected patients 5-year survival in excess of 50% can be achieved in patients harboring T3N0 disease.Offering en-bloc resection of lung cancer invading chest wall to patients with T3N1 or T3N2 disease is controversial.

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“…Furthermore, this study detected differences in overall survival (OS) between patients with pT3N0M0 NSCLC of different histologic types, a factor not accounted for in the eighth edition staging system. Other groups have described the importance of unique treatment plans for patients with different subtypes of pT3N0M0 NSCLC, such as those requiring chest wall resection 8 , 9 In combination, these reports reflect the profound diversity of patients diagnosed with pT3N0M0 NSCLC and the limitations of eighth edition staging in fully conveying this clinically important heterogeneity.…”

Section: Introductionmentioning

confidence: 99%

Exploring the Potential Different Outcomes Associated With the Different Phenotypes Under the Shared Pathologic T3N0 Designation

Peng

Wightman

Ding

et al. 2021

JTO Clinical and Research Reports

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Introduction: The objective of this study was to compare overall survival (OS) between patients with pT1-2N1 versus pT3N0 NSCLC and various subtypes of pT3N0 NSCLC. Methods:The National Cancer Database was queried to identify treatment-naive patients with pathologic stage IIB primary NSCLC. Patients were included if they were diagnosed with pT3N0 or pT1-2N1 NSCLC and received definitive surgery within 4 months of diagnosis. The pT3N0 cohort was subdivided by single versus multiple concurrent T3 descriptors and single-T3 subtypes. The 5-year OS was compared using the Kaplan-Meier method, and the Cox proportional-hazards model was used to identify prognostic factors for death.Results: A total of 16,770 patients were included (pT3N0: 7179; pT1-2N1: 9591). pT3N0 NSCLC was associated with greater 5-year OS than pT1-2N1 NSCLC (52.4% versus 47.8%, p < 0.0001). Among patients receiving adjuvant chemotherapy after surgery, multiple-T3 pT3N0 NSCLC was associated with lower 5-year OS than single-T3 pT3N0 NSCLC (49.0% versus 63.3%, p < 0.0001), and chest wallonly pT3N0 NSCLC was associated with the lowest 5-year OS across single-T3 subtypes (additional nodule: 68.3%; size: 64.5%; chest wall: 52.2%, p < 0.0001). Adjuvant chemotherapy was associated with decreased risk of death in the pT3N0 cohort (hazard ratio ¼ 0.65, confidence interval: 0.59-0.71, p < 0.0001).Conclusions: Patients with pT3N0 NSCLC experience greater 5-year OS after surgery compared with those with pT1-2N1 NSCLC. Multiple-T3 and chest wall-only pT3N0 NSCLC are associated with worse 5-year OS and increased risk of death relative to other T3 subtypes. Future staging systems should consider including notation distinguishing multiple T3 descriptors in pT3N0 NSCLC.

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A prospective, multi-institutional phase II study of induction chemoradiotherapy followed by surgery in patients with non-small cell lung cancer involving the chest wall (CJLSG0801).

Cited by 3 publications

References 0 publications

The Outcomes of Induction Chemoradiotherapy Followed by Surgery for Clinical T3-4 Non-Small Cell Lung Cancer

The Outcomes of Induction Chemoradiotherapy Followed by Surgery for Clinical T3-4 Non-Small Cell Lung Cancer

A narrative review of surgical management of lung cancer involving the chest wall: oncologic results

Exploring the Potential Different Outcomes Associated With the Different Phenotypes Under the Shared Pathologic T3N0 Designation

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