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:10.1016/j.lungcan.2016.12.011

Cited by 20 publications

(17 citation statements)

References 17 publications

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“…These studies suggest that multimodal therapy, including systemic treatment for distant control (chemotherapy), is essential in these patients. Reports also indicate that preoperative chemotherapy might make tumors more operable, improve the likelihood of complete resection, eradicate the chances of distant micro-metastases, and finally improve OS [ 7 – 9 ]. However, with the advent of radiotherapy, another local treatment, the question arises of whether its addition to chemotherapy can have any additional benefits for patients with stage IIIA/N2 NSCLC.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have indicated that induction chemotherapy has the ability to make tumors more operable, improve the likelihood of a complete resection, and eradicate the chances of distant micro-metastases, thereby improving the final survival [ 7 – 9 ]. These findings led to the inclusion and recommendation of induction chemotherapy for resectable stage IIIA/N2 patients before their surgery.…”

Section: Introductionmentioning

confidence: 99%

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Comparing the benefits of chemoradiotherapy and chemotherapy for resectable stage III A/N2 non-small cell lung cancer: a meta-analysis

et al. 2018

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BackgroundInduction chemotherapy has been shown to improve survival of patients with stage III A/N2 (T1–3, N2, M0) non-small cell lung cancer (NSCLC), followed by resection, but the benefits of neoadjuvant radiotherapy still remain controversial.MethodsPubMed, Embase, and Cochrane library databases were searched for relevant randomized controlled trials (RCTs) comparing the outcomes of induction chemoradiotherapy over induction chemotherapy, in patients with resectable stage IIIA/N2 NSCLC. Odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs) were calculated using random- or fixed-effects model, and heterogeneity was assessed using I2 test. Publication bias was examined by funnel plots analysis.ResultsA total of three RCTs met the inclusion criteria of our meta-analysis. The pooled results demonstrated that, in comparison to induction chemotherapy, induction chemoradiotherapy has a significant benefit in tumor response, mediastinal downstaging, and pathological complete response of mediastinal lymph nodes. In addition, no more peri-intervention mortality was detected in patients from chemoradiotherapy group, and a higher number of patients from this group had R0 resection. However, our results did not show any difference between overall survival and progression-free survival after 2, 4, and 6 years of follow-ups, in patients undergoing radiation therapy vs. induction chemotherapy.ConclusionPreoperative chemoradiotherapy, as compared to induction chemotherapy alone, is associated with similar peri-intervention mortality, a greater tumor response, mediastinal nodule downstaging, and rate of R0 resection, but does not improve survival of resectable stage IIIA/N2 NSCLC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing the benefits of chemoradiotherapy and chemotherapy for resectable stage III A/N2 non-small cell lung cancer: a meta-analysis

et al. 2018

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“…There is scarce data to support neoadjuvant chemotherapy or chemoradiotherapy for lung cancer with chest wall invasion. Nonetheless, a recent, multi-institutional, phase II Japanese study of induction chemoradiotherapy followed by surgery in patients with NSCLC involving the chest wall showed that the treatment strategy was safe and effective with a high rate of pathologic response (45).…”

Section: Adjuvant and Neoadjuvant Therapymentioning

confidence: 99%

Video-assisted thoracoscopic surgery lobectomy with chest wall resection

Agnol¹,

Oliveira²,

Ugalde

2018

J. Thorac. Dis.

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Lung cancer presents with chest wall invasion in 5-8% of patients, which imparts some treatment challenges. Surgical resection is currently the standard of care, and there are some controversies regarding the best approach. Published series and case reports confirm the safety and feasibility of video-assisted thoracoscopic surgery (VATS) in highly complex surgical cases including lobectomy with chest wall resection of locally advanced lung cancer. In this article, we present the clinical indications of locally advanced lung cancer that infiltrates the chest wall, the modalities for and importance of accurately staging lung cancers with chest wall invasion, and the technical aspects of accomplishing a safe and oncologically sound extended resection through VATS.

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“…Although many patients with stage IIIA NSCLC undergo complete resection, they are not completely cured and the 5-year survival rate of patients treated with surgery only remains unsatisfactory [1,2]. Induction and adjuvant chemotherapy have been demonstrated to improve the survival rate of patients with stage IIIA-N2 NSCLC [3][4][5]. A number of patients are unexpectedly found to have II-IA-N2 disease at the time of thoracoscopy or thoracotomy, with an occurrence rate of 2.0-18.5% [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Optimal Adjuvant Therapy in Resected Stage IIIA-N2 Non-Small-Cell Lung Cancer Harboring EGFR Mutations

Wen

Wang

et al. 2020

Oncol Res Treat

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Background: Some non-small-cell lung cancer (NSCLC) patients are unexpectedly diagnosed with stage IIIA-N2 disease at the time of thoracoscopy or thoracotomy. Because of the limited statistical evidence of induction chemotherapy for these patients, it is necessary to develop more profound treatment strategies. Methods: The demographic and clinical characteristics of patients with stage IIIA-N2 NSCLC harboring epidermal growth factor receptor (EGFR) mutations after radical resection were retrospectively reviewed. The patients were divided into 3 groups based on treatment: EGFR tyrosine kinase inhibitors (EGFR-TKIs, erlotinib or gefitinib), adjuvant chemotherapy (docetaxel plus cisplatin), and combination treatment (chemotherapy plus EGFR-TKIs). The effect of adjuvant therapy on survival rate was assessed using univariate and Cox regression analyses. Results: Patients receiving EGFR-TKIs alone showed significantly improved disease-free survival (DFS; p = 0.025) when compared to those receiving chemotherapy alone. Compared to chemotherapy alone, the combination of chemotherapy and EGFR-TKIs resulted did not significantly improve DFS (p < 0.001) and overall survival (OS p < 0.001). The combination of EGFR-TKIs with chemotherapy as adjuvant therapy led to improvements in both DFS (p = 0.116) and OS (p = 0.039) compared to patients receiving a EGFR-TKI monotherapy. Toxicities were mild in the 3 treatment groups. Conclusions: Our study demonstrated that adjuvant EGFR-TKI treatment significantly increased the DFS of patients with stage IIIA-N2 NSCLC when compared with cisplatin-based chemotherapy. The use of EGFR-TKIs and chemotherapy is recommended in the setting of combined-modality therapy.

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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 20 publications

References 17 publications

Comparing the benefits of chemoradiotherapy and chemotherapy for resectable stage III A/N2 non-small cell lung cancer: a meta-analysis

Comparing the benefits of chemoradiotherapy and chemotherapy for resectable stage III A/N2 non-small cell lung cancer: a meta-analysis

Video-assisted thoracoscopic surgery lobectomy with chest wall resection

Optimal Adjuvant Therapy in Resected Stage IIIA-N2 Non-Small-Cell Lung Cancer Harboring EGFR Mutations

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