Oncological outcomes from trimodality therapy receiving definitive doses of neoadjuvant chemoradiation (≥60 Gy) and factors influencing consideration for surgery in stage III non-small cell lung cancer

Vyfhuis, M.A.L.; Bhooshan, Neha; Burrows, W.; Turner, Michelle; Suntharalingam, Mohan; Donahue, James M.; Nichols, Elizabeth M.; Feliciano, Josephine; Bentzen, Søren M.; Badiyan, Shahed N.; Carr, Shamus R.; Friedberg, Joseph S.; Simone, Charles B.; Edelman, Martin J.; Feigenberg, Steven J.; Mohindra, Pranshu

doi:10.1016/j.adro.2017.07.009

Cited by 19 publications

(13 citation statements)

References 25 publications

(41 reference statements)

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“…As shown in other retrospective studies, patients selected for trimodality therapy tend to be younger, have better ECOG PS, and less advanced nodal stage. [23][24][25] There was higher use of PET scan as part of staging for trimodality patients, which may have assisted in further patient selection to exclude patients with undetected metastatic disease. CNS staging was used less frequently in the combined-modality cohort, which if anything should bias towards a worse outcome in this group as there may have been more patients with baseline undetected brain metastases.…”

Section: Discussionmentioning

confidence: 99%

Real-World Treatment of Stage III NSCLC: The Role of Trimodality Treatment in the Era of Immunotherapy

Moore

Leung²,

et al. 2019

Journal of Thoracic Oncology

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Introduction: Curative intent treatment of stage III NSCLC is variable and influenced by both patient and disease characteristics. We performed a real-world analysis of curative therapies in stage III NSCLC, and explored the impact of known prognostic factors on outcome. Methods: A retrospective review was completed of all patients with stage III NSCLC between January 2005 and December 2012. Cases were filtered to identify those receiving curative intent therapy including surgery, radiotherapy (RT), chemoradiotherapy (CRT), and combined modality with surgery (S þ RT). Information was collected on known prognostic and predictive factors, and immunotherapy eligibility per the PACIFIC trial. The primary outcome measure was overall survival. Results: A total of 638 patients with stage III NSCLC were referred and received curative intent treatment. Of these, 66 (10%) received surgery, 95 (15%) RT, 410 (64%) CRT, and 67 (11%) combined S þ RT. Median overall survival (OS) was similar for surgery (28.6 mo) and CRT (27.0 mo), inferior for RT alone (17.5 mo), and superior for S þ RT (55.8 mo). In a multivariate model only, Eastern Cooperative Oncology Group performance status (ECOG PS) and treatment cohort significantly influenced OS. In a case-matched analysis, the median OS for CRT was 31.9 months, compared to 55.8 months with trimodality treatment. Overall, 61% of patients receiving CRT and 88% of those receiving trimodality therapy would have been potentially eligible for adjuvant immunotherapy. Conclusions: In stage III NSCLC, the performance of surgery and CRT are similar after controlling for known prognostic factors. Radiotherapy alone is associated with worse outcomes. Combined S þ RT appears to provide a significant benefit above other modalities, albeit in highly selected patients.

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Section: Discussionmentioning

confidence: 99%

Real-World Treatment of Stage III NSCLC: The Role of Trimodality Treatment in the Era of Immunotherapy

Moore

Leung²,

et al. 2019

Journal of Thoracic Oncology

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“…The details of patient selection for trimodality therapy and the oncological outcomes have been previously reported. 10 For follow-up, patients were normally followed with serial CT or PET-CT scans as clinically indicated every 3 months for the first year, 4 to 6 months for the next 2 to 5 years, and then yearly thereafter.…”

Section: Patient Population and Treatmentmentioning

confidence: 99%

“…3 Population-based assessments are important in relaying information about trends and general outcomes based on marital status, but because they are large, they often lack patient-specific information such as nutrition, immunologic status, and variability in treatment paradigms, all of which can independently have an impact on overall survival (OS) in stage III NSCLC. [8][9][10] In addition, population analyses have typically included patients of all cancer stages and hence involved a multitude of treatment approaches ranging from curative to palliative. There are limited well-annotated institutional data on the association of marital status on nonmetastatic, locally advanced (LA-NSCLC) in the setting of National Comprehensive Cancer Network-guided, standard-of-care definitive treatment.…”

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confidence: 99%

Marriage predicts for survival in patients with stage III non–small-cell lung cancer

Vyfhuis¹

2018

JCSO

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Background Comprehensive analysis of prognostic significance of marital status in patients with stage III non-small-cell lung cancer (NSCLC) when adjusted for patient-, disease-, and treatment-specific factors, including the interaction with racial, nutritional, and immunologic status, is lacking. Objective To evaluate whether marital status is an independent predictor of clinical outcomes in patients with stage III NSCLC who are treated uniformly with curative intent. Methods The Kaplan-Meier method and Cox proportional hazards model were used to estimate the overall survival and freedom from recurrence (FFR) in 355 patients with stage III NSCLC who were treated during 2000-2013. Results 52% of patients in the cohort were married and were more likely to self-identify as white (P < .0001), reside in zip codes with a higher household median income (P < .0001), have Eastern Cooperative Oncology Group Performance Status of 0 (P = .001), have higher pretreatment albumin (P = .009), undergo surgery (P = .001), and have insurance (P = .029). On multivariate analysis, marital status remained an independent predictor of survival and was associated with a 40% decreased risk of death (P < .0001), further stratifying outcomes beyond gender and stage grouping. FFR was comparable between the 2 groups (P = .108). Limitations Retrospective analysis; information on individual support system beyond the marital and insurance status and zip code income was not available. Conclusions In a cancer such as NSCLC, in which modern therapeutic approaches have yielded only modest survival improvements despite considerable treatment-related toxicity, marital status remains an independent predictor for survival. Marriage is likely a surrogate for better psychosocial support; the scale of survival improvements seen justifies investments into supportive care interventional strategies to help advance overall outcomes.

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“…The most recent studies about this topic are retrospective analyses [31][32][33][34]. Aggarwal et al [31] compared surgical treatment and dCR: lobectomy conferred a survival benefit over dCR alone (39 vs 22 months, p = 0.038) while pneumonectomy did not (28 vs 22 months, p = 0.534).…”

Section: Local Control: Surgery or Radiotherapy?mentioning

confidence: 99%

Resectable IIIA-N2 Non-Small-Cell Lung Cancer (NSCLC): In Search for the Proper Treatment

Brascia

Iaco

Schiavone

et al. 2020

Cancers

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Locally advanced non-small cell lung cancer accounts for one third of non-small cell lung cancer (NSCLC) at the time of initial diagnosis and presents with a wide range of clinical and pathological heterogeneity. To date, the combined multimodality approach involving both local and systemic control is the gold standard for these patients, since occult distant micrometastatic disease should always be suspected. With the rapid increase in treatment options, the need for an interdisciplinary discussion involving oncologists, surgeons, radiation oncologists and radiologists has become essential. Surgery should be recommended to patients with non-bulky, discrete, or single-level N2 involvement and be included in the multimodality treatment. Resectable stage IIIA patients have been the subject of a number of clinical trials and retrospective analysis, discussing the efficiency and survival benefits on patients treated with the available therapeutic approaches. However, most of them have some limitations due to their retrospective nature, lack of exact pretreatment staging, and the involvement of heterogeneous populations leading to the awareness that each patient should undergo a tailored therapy in light of the nature of his tumor, its extension and his performance status.

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Oncological outcomes from trimodality therapy receiving definitive doses of neoadjuvant chemoradiation (≥60 Gy) and factors influencing consideration for surgery in stage III non-small cell lung cancer

Cited by 19 publications

References 25 publications

Real-World Treatment of Stage III NSCLC: The Role of Trimodality Treatment in the Era of Immunotherapy

Real-World Treatment of Stage III NSCLC: The Role of Trimodality Treatment in the Era of Immunotherapy

Marriage predicts for survival in patients with stage III non–small-cell lung cancer

Resectable IIIA-N2 Non-Small-Cell Lung Cancer (NSCLC): In Search for the Proper Treatment

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