Feasibility and prognostic benefit of induction chemoradiotherapy followed by surgery in patients with locally advanced non-small cell lung cancer

Abstract

Background: The optimal treatment for patients with resectable non-small cell lung cancer (NSCLC) involving adjacent organs (T3 or T4) and/or cN2 remains unclear. We investigated whether or not induction chemoradiotherapy (ICRT) followed by surgery improves the survival. Methods: We retrospectively analyzed 84 patients with NSCLC involving the adjacent organs and/or cN2 who underwent ICRT followed by surgery at our hospital from 2006 to 2018. Presurgical treatment consisted of 2 courses of platinum-doublet and concurrent radiotherapy (40-50 Gy) to the tumor and involved field.Results: All 84 patients completed ICRT. One patient died after completion of ICRT due to bacterial pneumonia. Radiological responses to ICRT were a complete response (CR), n=1; partial response (PR), n=48; stable disease (SD), n=32; and progressive disease (PD), n=2 (overall response rate: 58.3%). Eightyone patients underwent radical surgery. The procedures included lobectomy, n=66; bilobectomy, n=7; pneumonectomy, n=6; and segmentectomy, n=2 (including 49 extended resections). Seventy-three patients (90%) underwent complete resection. The postoperative morbidity rate was 30%. The 30-and 90-day mortality rates were 1.2% and 2.4%, respectively. A pathological CR (Ef3) and major response (Ef2) were achieved in 17 (21.0%) and 38 (46.9%) patients, respectively; a minor response (Ef1) was observed in 26 (32%). The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 58.0% and 45.6%, respectively. The median survival time was 73.2 months. Based on the response to ICRT, patients with radiological CR or PR showed better 5-year OS than those with SD (63.7% vs. 40.0%, P=0.020). Patients with Ef3 or Ef2 demonstrated a much better 5-year OS than those with Ef1 (65.0% vs. 24.4%, P=0.005). Conclusions: ICRT followed by surgery for patients with NSCLC involving the adjacent organs and/or cN2 was feasible and improved the survival. A CR/PR or Ef2/Ef3 after ICRT led to a better prognosis.

Role of fluorodeoxyglucose-positron emission tomography in predicting the pathological response and prognosis after neoadjuvant chemoradiotherapy for locally advanced non-small-cell lung cancer

“…ICRT followed by surgery was performed for resectable locally advanced NSCLC invading adjacent organs (classified as invasive T3 or T4) and/or cN2. In our previous study, we found that a favourable prognosis could be expected when a major pathological response (Ef2 or Ef3) was achieved by concurrent chemoradiotherapy followed by surgery in patients with potentially resectable locally advanced NSCLC [ 18 ]. If a good pathological response can be predicted preoperatively, we can select patients who can be expected to have a good prognosis with surgical treatment.…”

Sleeve lobectomy versus lobectomy for primary treatment of non‐small–cell lung cancer: A single‐center retrospective analysis

“…Sleeve lobectomy may also present the only surgical option in patients with limited cardiopulmonary function in contrast to pneumonectomy. The treatment alternative for these patients would be definitive chemoradiation or stereotactic radiation with not always equal oncological outcomes 3 . The ratio of sleeve lobectomy to lobectomy or bilobectomy in Germany varies between 4% and 26% according to the annual 2019 report for certified lung cancer centers.…”

“…oncological outcomes. 3 The ratio of sleeve lobectomy to lobectomy or bilobectomy in Germany varies between 4% and 26% according to the annual 2019 report for certified lung cancer centers. Although the functional advantages of sleeve lobectomy are well-documented 4 and incomplete resection of bronchus margins usually leads to non-favorable oncological results, the intraoperative willingness or judgment of the thoracic surgeon to perform a sleeve lobectomy may be negatively influenced by concerns regarding anastomosis-related complications.…”