Surgery News - May 2008 - (Page 17)

M AY 2 0 0 8 • SURGERY NEWS THORACIC 17 Survival Improves for Downstaged Advanced Lung Ca BY DAMIAN MCNAMARA Else vier Global Medical Ne ws F O R T L A U D E R D A L E , F L A . — Stage IIIa non–small-cell lung cancer patients who achieve stage 0 or I disease after chemoradiotherapy induction have improved long-term surgery survival rates, but these are significantly lower than survival rates in stage I patients with surgery only, according to a retrospective study. Previous research demonstrated a survival benefit to downstaging stage IIIa non–small-cell lung cancer (NSCLC). For example, of 53 patients treated with chemoradiotherapy induction, 22 achieved a major pathologic response and were reclassified as stage 0, I, or II in one report (J. Thorac. Cardiovasc. Surg. 2004;127:10813). Compared with a 24% survival rate among nonresponders, the downstaged group had a 48% survival rate. The 5-year actuarial survival was 31%. In another study, researchers found a 67% tumor downstaging and an “encouraging” 37% 5year survival among 42 patients with advanced NSCLC who were also treated with chemoradiotherapy ( J. Clin. Oncol. 1997;15:712-22). Again, a significantly better survival rate was observed among downstaged participants. “Our study confirmed this,” Dr. Stefano Margaritora said at the annual meeting of the Society of Thoracic Surgeons. “But going further into this problem, do cases with stages 0-I after induction therapy have the same prognosis as surgery patients?” asked Dr. Margaritora, a thoracic surgeon at Catholic University, Rome. Dr. Margaritora and his associates assessed 80 patients with stage IIIa or IIIb NSCLC downstaged to stage 0 or I by induction therapy. They compared the 3year and 5-year survival rates in this group with 367 early-stage NSCLC patients scheduled for surgery only. Demographics were comparable between groups, he said. Multimodal induction therapy included various chemotherapy protocols (for example, carboplatin, cisplatin/5-FU, or cisplatin and gemcitabine) and concurrent radiation. The 80 patients who responded were from a group of 226 patients treat- ed with the induction protocol between 1992 and 2005. For the downstaged patients, 3-year survival was 48% and 5-year survival was 46%. For the early-stage controls, 3-year survival was 82% and 5-year survival was 76%. “This is an excellent study, elegantly presented,” said study discussant Dr. Douglas E. Wood, chief of general thoracic surgery at the University of Washington Medical Center, Seattle. “It has the usual limitations that a retrospective study might have.” There may have been selec- tion bias, for example, because the researchers included only patients who had surgery. On the other hand, its “enormous strengths include rigorous standardization of techniques, a great followup, and excellent clinical results.” There was no difference in 5-year survival between the 44 stage IIIa and 36 initial stage IIIb patients who responded to induction. Complication rates were similar between groups, Dr. Margaritora said. All the cancer in the first group was locally advanced; no patient in either group had a nodal metastasis, he added. How accurate was pathology for nodal metastasis? Dr. Wood asked. “Regarding nodal staging, all were histocytologically proven in this study,” Dr. Margaritora replied. Despite the improved survival among the early-stage patients who had surgery without induction, Dr. Margaritora said, “downstaging to pathologic stage 0 or I after induction therapy for clinical stage III non–small-cell lung cancer significantly improves long-term survival.” See current and archived issues of online at www.facs.org. And don't miss the exclusive online-only articles available on the Web site. More news is just a click away! http://www.acs-resource.org http://www.facs.org http://www.acs-resource.org

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Surgery News - May 2008 Contents New Lung Approach Speeds Extubation Innovative GI Procedures May Improve Diabetes Quality Programs Differ on Risk Data Crystal Ball Medical Modeling Ventricular Valve Taking Stock

Surgery News - May 2008

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