Neo-adjuvant chemo-radiation to 60 gray followed by surgery for locally advanced non-small cell lung cancer patients: Evaluation of trimodality strategy

Sarit Appel, Jeffry Goldstein, Marina Perelman, Tatiana Rabin, Damien Urban, Amir Onn, Tiberiu R. Shulimzon, Ilana Weiss, Sivan Lieberman, Edith M. Marom, Nir Golan, David Simansky, Alon Ben-Nun, Yaacov Richard Lawrence, Jair Bar, Zvi Symon

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations

Abstract

Background: Neoadjuvant chemo-radiation therapy (CRT) dosages in locally advanced non-small cell lung cancer (NSCLC) were traditionally limited to 45 Gray (Gy). Objectives: To retrospectively analyze outcomes of patients treated with 60 Gy CRT followed by surgery. Methods: A retrospective chart review identified patients selected for CRT to 60 Gy followed by surgery between August 2012 and April 2016. Selection for surgery was based on the extent of disease, cardiopulmonary function, and response to treatment. Pathological response after neoadjuvant CRT was scored using the modified tumor regression grading. Local control (LC), disease free survival (DFS), and overall survival (OS) were estimated by the Kaplan-Meier method. Results: Our cohort included 52 patients: 75% (39/52) were stage IIIA. A radiation dose of 60 Gy (range 50–62Gy) was delivered in 82.7%. Surgeries performed included: lobectomy, chest-wall resection, and pneumonectomy in 67.3%, 13.4%, and 19.2%, respectively. At median follow-up of 22.4 months, the 3 year OS was 74% (95% confidence interval [CI] 52–87%), LC was 84% (95%CI 65–93), and DFS 35% (95%CI 14–59). Grade 4–5 postoperative complications were observed in 17.3% of cases and included chest wall necrosis (5.7%), broncopleural fistula (7.7%), and death (3.8%). A major pathologic regression with < 10% residual tumor occurred in 68.7% of patients (36/52) and showed a trend to improved OS (P = 0.1). Pneumonectomy cases had statistically worse OS (P = 0.01). Conclusions: Major pathologic regression was observed in 68.7% with 60 Gy neoadjuvant CRT with a trend to improved survival. Pneumonectomy correlated with worse survival.

Original languageEnglish
Pages (from-to)614-619
Number of pages6
JournalIsrael Medical Association Journal
Volume19
Issue number10
StatePublished - 1 Oct 2017
Externally publishedYes

Keywords

  • Completion lobectomy
  • Locally advanced non-small cell lung cancer (NSCLC)
  • Neoadjuvant chemo-radiation therapy (CRT)
  • Pathologic response
  • Trimodality

Fingerprint

Dive into the research topics of 'Neo-adjuvant chemo-radiation to 60 gray followed by surgery for locally advanced non-small cell lung cancer patients: Evaluation of trimodality strategy'. Together they form a unique fingerprint.

Cite this