Is neoadjuvant chemoradiotherapy a feasible strategy for stage IIIA-N2 non-small cell lung cancer? Mature results of the randomized IFCT-0101 phase II trial

Girard, Nicolas; Mornex, F.; Douillard, Jean-Yves; Bossard, Nadine; Quoix, Élisabeth; Beckendorf, V.; Grunenwald, Dominique; Amour, Elodie; Milleron, B.

doi:10.1016/j.lungcan.2009.10.003

Cited by 69 publications

(55 citation statements)

References 43 publications

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“…The addition of radiotherapy to chemotherapy has been associated with a high rate of complete resection, a satisfying rate of complete pathologic response, and high mediastinal clearance in cases of N2 disease. Until recently, only small randomized trials have compared neoadjuvant chemoradiation to neoadjuvant chemotherapy, but were not sufficiently conclusive . The recently published Swiss cooperative group phase III randomized trial is the only one to include a sufficient number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Until recently, only small randomized trials have compared neoadjuvant chemoradiation to neoadjuvant chemotherapy, but were not sufficiently conclusive. [42][43][44][45] The recently published Swiss cooperative group phase III randomized trial is the only one to include a sufficient number of patients. It demonstrated the superiority of neoadjuvant chemoradiation over neoadjuvant chemotherapy regarding overall response rate, complete resection rate and local control, while no increased hematologic toxicity or postoperative death occurred.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non‐small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience

et al. 2017

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BackgroundIn spite of the progress made in neoadjuvant therapy for operable non small‐cell lung cancer (NSCLC), many issues remain unsolved, especially in locally advanced stage IIIA.MethodsRetrospective data of 163 patients diagnosed with stage IIIA NSCLC after surgery was analyzed. The patients were divided into two groups: a preoperative chemotherapy group including 59 patients who received platinum‐etoposide doublet treatment before surgery, and an upfront surgery group including 104 patients for whom surgical resection was the first treatment step. Adjuvant chemotherapy or/and radiotherapy was administered to 139 patients (85.3%), while 24 patients (14.7%) were followed‐up only.ResultsThe rate of N2 disease was significantly higher in the upfront surgery group (P < 0.001). The one‐year relapse rate was 49.5% in the preoperative chemotherapy group compared to 65.4% in the upfront surgery group. There was a significant difference in relapse rate in relation to adjuvant chemotheraphy treatment (P = 0.007). The probability of relapse was equal whether radiotherapy was applied or not (P = 0.142). There was no statistically significant difference in two‐year mortality (P = 0.577). The median survival duration after two years of follow‐up was 19.6 months in the preoperative chemotherapy group versus 18.8 months in the upfront surgery group (P = 0.608 > 0.05).ConclusionThere was significant difference in preoperative chemotherapy group regarding relapse rate and treatment outcomes related to the lymph node status comparing to the upfront surgery group. Neoadjuvant/adjuvant chemo‐therapy is a part of treatment for patients with stage IIIA NSCLC, but further investigation is required to determine optimal treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non‐small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience

et al. 2017

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“…Stage IIIA(N2) accounts for a minority but still significant number of patients with lung cancer, considering that lung cancer is the most common cause of cancer-related mortality in the United States with over 222,000 new cases and over 157,000 deaths in 2010 [1,2,35,36]. The reported 5-year survival rates for stage IIIA(N2) vary from 15–42%[2, 4, 7, 9, 37].…”

Section: Discussionmentioning

confidence: 99%

“…However, the role of adding induction radiation therapy to chemotherapy and even the role of surgery when radiation and chemotherapy have been used is unclear [8–10, 40]. Adding induction radiation therapy to induction chemotherapy has not been shown to give a survival benefit compared to induction chemotherapy alone in randomized controlled trials, phase II studies, or retrospective reviews [35, 41–45]. Induction chemotherapy and radiation therapy (45 Gy) followed by surgical resection for patients with stage IIIA disease has been demonstrated to be feasible, but did not improve survival compared to chemotherapy and radiation (61 Gy) without surgical resection in a randomized phase III study [11].…”

Section: Discussionmentioning

confidence: 99%

Variability in the Treatment of Elderly Patients with Stage IIIA (N2) Non–Small-Cell Lung Cancer

Berry

Worni

Pietrobon

et al. 2013

Journal of Thoracic Oncology

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Introduction We evaluated treatment patterns of elderly patients with stage IIIA(N2) non-small cell lung cancer (NSCLC). Methods The use of surgery, chemotherapy, and radiation for patients with stage IIIA(T1-T3N2M0) NSCLC in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database from 2004–2007 was analyzed. Treatment variability was assessed using a multivariable logistic regression model that included treatment, patient, tumor, and census track variables. Overall survival (OS) was analyzed using the Kaplan-Meier approach and Cox proportional hazard models. Results The most common treatments for 2958 patients with stage IIIA(N2) NSCLC were radiation with chemotherapy (n=1065,36%), no treatment (n=534,18%), and radiation alone (n=383,13%). Surgery was used for 709 (24%) patients: 235 (8%) surgery alone; 40 (1%) surgery with radiation, 222 surgery with chemotherapy (8%), and 212 (7%) surgery, chemotherapy, and radiation. Younger age (p<0.0001), lower T-status (p<0.0001), female gender (p=0.04), and living in a census track with a higher median income (p=0.03) predicted surgery use. Older age (p<0.0001) was the only factor that predicted that patients did not get any therapy. The 3-year OS was 21.8±1.5% for all patients, 42.1±3.8% for patients that had surgery, and 15.4±1.5% for patients that didn’t have surgery. Increasing age, higher T-stage and Charlson Comorbidity index, and not having surgery, radiation, or chemotherapy were all risk factors for worse survival (all p-values<0.001). Conclusions Treatment of elderly patients with stage IIIA(N2) NSCLC is highly variable and varies not only with specific patient and tumor characteristics but also with regional income level.

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“…Since the publication of INT 0139 a number of studies have shown that in experienced hands the mortality rate of pneumonectomy is unchanged following chemoradiation [18, 19]. Moreover, a number of trials have been published showing a lack of clear survival benefit for chemoradiation over induction chemotherapy followed by surgery [20-22]. …”

Section: Discussionmentioning

confidence: 99%

High-Dose Radiotherapy as Neoadjuvant Treatment in Non-Small-Cell Lung Cancer

et al. 2018

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Background: Trimodality therapy (chemoradiation followed by surgery) provides a benefit in progression-free survival but not overall survival. We sought to determine if a high dose of radiation could be delivered safely and provide a clinical benefit. Methods: Consecutive patients with stage IIIA or IIIB non-small-cell lung cancer (NSCLC) treated with concurrent chemoradiotherapy followed by surgery were reviewed with IRB approval. Results: A total of 48 patients were treated from November 2007 to May 2014. Of these, 64% had stage IIIA disease while 36% had stage IIIB; 46% had adenocarcinoma, 34% squamous, and 23% NSCLC not otherwise specified. The median dose of chemoradiotherapy was 72 Gy (60–72). Overall, 86% of patients received cisplatin (50 mg/m²) and etoposide (50 mg/m²) concurrently with radiotherapy; 72% of patients underwent lobectomy following chemoradiotherapy and 28% underwent pneumonectomy. The 30- and 90-day mortality rates were 0%. The nodal downstaging rate was 82% and there was a 64% rate of pathologic complete response. The overall survival was 29.9 months (95% CI, 19–86 months). The median time to locoregional progression was 35.1 months and the median time to distant progression was 39.3 months. Locoregional failure was 8% and distant failure was 44%. Conclusion: High-dose preoperative chemoradiotherapy was safe and effective. This combination should be further considered.

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Is neoadjuvant chemoradiotherapy a feasible strategy for stage IIIA-N2 non-small cell lung cancer? Mature results of the randomized IFCT-0101 phase II trial

Cited by 69 publications

References 43 publications

Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non‐small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience

Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non‐small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience

Variability in the Treatment of Elderly Patients with Stage IIIA (N2) Non–Small-Cell Lung Cancer

High-Dose Radiotherapy as Neoadjuvant Treatment in Non-Small-Cell Lung Cancer

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