Neoadjuvante Radiochemotherapie gefolgt von kurativer Resektion im fortgeschrittenen Stadium IIIA/IIIB eines nicht kleinzelligen Lungenkarzinoms: prognostische Faktoren und Ergebnisse

Abstract

The role of surgical lung resection following neo-adjuvant radio-chemotherapy (RCT) in patients with locally advanced non-small cell lung cancer (NSCLC) is yet not clearly defined. The aim of our study was to analyze the postoperative survival and to identify relevant prognostic factors. 46 patients underwent curative resections after neo-adjuvant RCT for locally advanced NSCLC (IIIA/IIIB) between February 2008 and February 2015. A retrospective data analysis regarding preoperative regression status, perioperative mortality, postoperative survival, patho-histological remission, relapse pattern and other prognostic factors was performed. A neo-adjuvant RCT with a median radiation dose of 50.4 [range, 45-60] Gy was performed in 44 (96 %) patients. Partial and/or complete regression was observed in 32 (70 %) patients. R0-resection was achieved in 44 (96 %) patients. The 30-day mortality was 4 % and the perioperative morbidity was 37 %. The overall and progression free 5-year survival rate was 47 % and respectively 45 % [in median 58 months]. The 5-year survival rate of 64 % in the "responder"-group was significantly better when compared with 24 % in the "non-responder"-group (p = 0.038). The tri-modality therapy improved the prognosis in patients with locally advanced NSCLC (stage IIIA/IIIB). The complete patho-histological remission is an important prognostic factor for better long term survival. Dividing the patients in "responder" and "non-responder" after neo-adjuvant RCT may have large therapeutically consequences in the future.

The predictive value of 18F-FDG PET-CT for assessing the clinical outcomes in locally advanced NSCLC patients after a new induction treatment: low-dose fractionated radiotherapy with concurrent chemotherapy

“…In our population, we found good overall survival: this result is in line with that reported by some Authors [49, 50] in patients treated with standard chemo-radiotherapy and surgery but remarkably higher than that reported by other Authors [47, 51] in patients treated with induction chemotherapy. These data further suggest that the improvement of the overall survival seems to be influenced by: 1) surgery, that removing the disease, can play an important role in patients with locally advanced NSCLC; 2) induction therapy, particularly when concurrent low-dose radiotherapy is added, that boosts the subsequent treatment; 3) the personalization of the treatment that allows to tailor the therapy to the individual patient.…”