MD Conference Express - ELCC 2015 - (Page 22)

SELECTED UPDATES Table 2. Studies of Potentially Resectable or Baseline Unresectable Stage III (N2) NSCLC Study Study Design, Intervention No. of Patients, Stage/TNM Status Outcome Potentially resectable Betticher DC et al. Br J Cancer. 2006; Betticher DC et al. J Clin Oncol. 2003 Phase 2 RCT, IND-Ctx followed by surgery 90, IIIA (pN2) Perioperative mortality, 3%; median OS, 35 mo; 3-y relapse-free survival, 36% Decaluwé H et al. Eur J Cardiothorac Surg. 2009 Prospective consecutive surgical database, 2000 to 2006; IND-Ctx followed by surgery in responders and stable disease 92, IIIA (N2) Complete resection rate, 68%; in-hospital mortality, 2.3%; 5-y OS, 33% Lung Intergroup 0139 [Albain KS et al. Lancet. 2009] RCT; IND-CRT followed by surgery vs CRT alone 429, IIIA (pN2) Complete resection rate 88%; disease progression at 5 y: CRT + surgery, 22%; CRT alone, 11% German Lung Cancer Cooperative Group [Thomas M et al. Lancet Oncol. 2008] RCT; IND-Ctx followed by CRT and surgery vs IND-CT alone followed by surgery 558, III (A + B) 5-y OS survival in patients undergoing tumor resection: Ctx + CRT + surgery, 45%; Ctx + surgery, 42%; P = .82; postsurgical mortality: CRT, 9.2%; IND-CT alone, 4.5% SWOG 9416/Intergroup 0160 [Rusch VW et al. J Thorac Oncol. 2007; Rusch VW et al. J Thorac Cardiovasc Surg. 2001] RCT; IND-CRT followed by surgery in responders and stable disease 110, III cT3-T4N0, mediastinoscopy negative (Pancoast tumors) Complete resection rate, 92%; 5-y OS, 44%; 5-y OS in completely resected patients, 54% De Leyn P et al. J Thorac Oncol. 2009 Prospective consecutive surgical database, 2002 to 2008; IND-CRT followed by surgery in responders and stable disease 32, III cT3-T4 5-y survival, resected patients (n = 25): 77% Baseline unresectable EORTC 8947 [van Meerbeeck JP et al. J Natl Cancer Inst. 2007] RCT; IND-Ctx, responders randomized to RT or surgery ± PORT 579, IIIA-N2 5-y OS: resection 15.7% vs RT 14% (HR, 1.06; 95% CI, 0.84 to 1.35) CRT, chemoradiation therapy; IND-Ctx, induction chemotherapy; NSCLC, non-small cell lung cancer; OS, overall survival; PORT, postoperative radiation therapy; RCT, randomized clinical trial; RT, radiation therapy; TNM, tumor, node, and metastasis. compared with left pneumonectomy; 90-day mortality for all pneumonectomies was also higher than 30-day mortality [Kim et al. J Thorac Cardiovasc Surg. 2012]. Prof De Leyn noted that these findings highlight the need for careful patient selection for pneumonectomy and reporting of 90-day mortality. In regard to surgical volume, Bach and colleagues reported in 2001 that 44% of patients who had surgery at the highest volume centers survived 5 years postsurgery, compared with 33% of patients treated at the lowest volume centers (P < .001). A 2013 analysis of data on > 134 000 patients with NSCLC diagnosed in England 22 May 2015 between 2004 and 2008 found that high procedure volume was strongly associated with improved survival, a higher resection rate, and a higher percentage of resections in patients with higher levels of comorbidity [Lüchtenborg M et al. J Clin Oncol. 2013]. In conclusion, evidence reviewed in this session showed that unanswered questions still surround the role of PORT in the treatment of patients with stage III NSCLC, that the role of induction CRT is dependent on tumor resectability, and that type of surgery and hospital surgical volume are important factors in surgical outcomes. www.mdce.sagepub.com http://mdc.sagepub.com/

Table of Contents for the Digital Edition of MD Conference Express - ELCC 2015

Contents

MD Conference Express - ELCC 2015