Preoperative chemotherapy for stage IIIa (N2) lung cancer: The Sloan-Kettering experience with 136 patients

Martini, Nael; Kris, Mark G.; Flehinger, Betty J.; Gralla, Richard J.; Bains, Manjit S.; Burt, Michael; Heelan, Robert T.; McCormack, Patricia; Pisters, Katherine M.W.; Rigas, James R.; Rusch, Valerie W.; Ginsberg, Robert J.

doi:10.1016/0003-4975(93)91072-u

Cited by 343 publications

(147 citation statements)

References 24 publications

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“…It was previously reported that objective response was observed in >50% of cases (4,5,7,22) and certain studies reported that response to chemotherapy was a strong prognostic factor (4,7,21). Accordingly, in our study, grouping and N downstaging were found to be independent predictive factors associated with OS and DFS, reflecting response to chemotherapy.…”

Section: Patient No (%) --------------------------------------------supporting

confidence: 69%

“…According to a previous study, direct surgery for patients with clinically apparent N2 disease achieved a long-term survival rate of <10% of (2). However, certain phase II trials and a limited number of phase III trials suggested improved long-term survival for NSCLC patients with N2 disease treated with neoadjuvant therapy followed by surgical resection, compared with those undergoing surgery alone (3)(4)(5)(6)(7). Additionally, Pataer et al reported that the histopathological response to neoadjuvant chemotherapy was significantly associated with long-term overall survival (OS) in NSCLC patients with N2 disease (8).…”

Section: Introductionmentioning

confidence: 99%

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Surgery following neoadjuvant chemotherapy for non-small-cell lung cancer patients with unexpected persistent pathological N2 disease

Duan

Jiang

et al. 2015

Molecular and Clinical Oncology

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Abstract.Patients with mediastinal lymph node (LN) downstaging following neoadjuvant chemotherapy exhibit improved outcomes compared with patients with persistent N2 disease. The aim of this study was to compare clinicopathological characteristics and survival between patients with unexpected and expected persistent N2 disease following surgery for non-small-cell lung cancer (NSCLC). This retrospective analysis included 348 patients with NSCLC who underwent surgery following chemotherapy at the Shanghai Pulmonary Hospital, Tongji University School of Medicine, between 1995 and 2012. According to the results of the imaging examinations and postoperative pathology, the patients were divided into three groups, namely groups I (nodal downstaging, pN0-1), II (expected persistent N2 disease) and III (unexpected persistent N2 disease). The rates of overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify the independent risk factors for OS and DFS. The mortality rate was 1.1% during the postoperative period. Perioperative complications occurred in 45 patients (12.9%). The 5-year OS rate was 32.2, 6.3 and 25.9% in groups I, II and III, respectively (group I vs. III, P=0.023; and group III vs. II, P<0.001). The 5-year DFS rate was 30.1, 5.1 and 22.4% in groups I, II and III, respectively (group I vs. III, P=0.012; and group III vs. II, P<0.001). Grouping, predicted forced expiratory volume in 1 sec, N downstaging and skip N2 metastasis were identified as independent predictive factors associated with OS, whereas the independent risk factors associated with DFS were grouping and N downstaging. Patients with unexpected persistent N2 disease exhibited better survival compared with those with expected persistent N2 disease. Surgery following chemotherapy remains the optimal approach for a proportion of patients with persistent N2 disease.

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Section: Patient No (%) --------------------------------------------supporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Surgery following neoadjuvant chemotherapy for non-small-cell lung cancer patients with unexpected persistent pathological N2 disease

Duan

Jiang

et al. 2015

Molecular and Clinical Oncology

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“…It was not possible to include all of these factors in the multivariate model (this table presents the updated analysis of our previous report (Betticher et al, 2003)). and gemcitabine preoperatively, the median survival was 18.9 months (Van Zandwijk et al, 2000), while two other trials reported median survival times of 19 and 22 months for patients with stage IIIA pN2 NSCLC who received neoadjuvant chemotherapy (Martini et al, 1993;Rosell et al, 1999). We sought to identify characteristics of the neoadjuvant chemotherapy, as well as other prognostic factors, which would allow enhancement of therapy and help select patients for thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors affecting long-term outcomes in patients with resected stage IIIA pN2 non-small-cell lung cancer: 5-year follow-up of a phase II study

et al. 2006

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The aim was to investigate the efficacy of neoadjuvant docetaxel -cisplatin and identify prognostic factors for outcome in locally advanced stage IIIA (pN2 by mediastinoscopy) non-small-cell lung cancer (NSCLC) patients. In all, 75 patients (from 90 enrolled) underwent tumour resection after three 3-week cycles of docetaxel 85 mg m À2 (day 1) plus cisplatin 40 or 50 mg m À2 (days 1 and 2). Therapy was well tolerated (overall grade 3 toxicity occurred in 48% patients; no grade 4 nonhaematological toxicity was reported), with no observed late toxicities. Median overall survival (OS) and event-free survival (EFS) times were 35 and 15 months, respectively, in the 75 patients who underwent surgery; corresponding figures for all 90 patients enrolled were 28 and 12 months. At 3 years after initiating trial therapy, 27 out of 75 patients (36%) were alive and tumour free. At 5-year follow-up, 60 and 65% of patients had local relapse and distant metastases, respectively. The most common sites of distant metastases were the lung (24%) and brain (17%). Factors associated with OS, EFS and risk of local relapse and distant metastases were complete tumour resection and chemotherapy activity (clinical response, pathologic response, mediastinal downstaging). Neoadjuvant docetaxel -cisplatin was effective and tolerable in stage IIIA pN2 NSCLC, with chemotherapy contributing significantly to outcomes.

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“…In a historical series, MARTINI et al [95] showed a response rate of 77% in patients receiving cisplatin-based chemotherapy and a complete resection rate of 65%. This was followed by two randomised trials of surgery alone versus neoadjuvant chemotherapy followed by surgery in stage IIIa patients, which showed a survival benefit in those receiving preoperative chemotherapy [96,97].…”

Section: N2 Diseasementioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

European Respiratory Review

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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Preoperative chemotherapy for stage IIIa (N2) lung cancer: The Sloan-Kettering experience with 136 patients

Cited by 343 publications

References 24 publications

Surgery following neoadjuvant chemotherapy for non-small-cell lung cancer patients with unexpected persistent pathological N2 disease

Surgery following neoadjuvant chemotherapy for non-small-cell lung cancer patients with unexpected persistent pathological N2 disease

Prognostic factors affecting long-term outcomes in patients with resected stage IIIA pN2 non-small-cell lung cancer: 5-year follow-up of a phase II study

Surgery for nonsmall cell lung cancer

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