Is trimodality approach better then bimodality in stage IIIA, N2 positive non-small cell lung cancer?

Byeong Bae Park, Joon Oh Park, Hojoong Kim, Yong Chan Ahn, Yong Soo Choi, Kwhanmien Kim, Jhingook Kim, Young Mog Shim, Jin Seok Ahn, Keunchil Park

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Abstract

Background: Neoadjuvant treatment followed by surgery is currently being investigated for locally advanced non-small cell lung cancer (NSCLC). This study reports efficacy, toxicity and feasibility of neoadjuvant chemotherapy with concurrent radiotherapy (CCRT) in stage IIIA, N2 positive NSCLC. Methods: From March 2001 to February 2004, 52 patients with histologically confirmed stage IIIA, N2 positive NSCLC were registered. Patients received preoperative CCRT that consisted of weekly paclitaxel plus platinum chemotherapy and concurrent radiotherapy followed by surgery. Results: Overall response rate was 76.9% (95% CI, 64-88%). The major grade 3-4 toxicities were radiation esophagitis (15.4%) and neutropenia (11.5%), and treatment-related mortality rate was 1.9%. Forty-two of 52 patients (80.8%) subsequently underwent surgical resection and 35 of 52 patients (67.3%) underwent complete resection. Among them, pathological complete response was obtained in 4.8%. Pathological downstaging rate to N0-1 and stage 0-II at surgery were 69.0% and 66.7%, respectively. The perioperative major morbidity rate was 23.8% and perioperative mortality was 2.4%. At a median follow-up of 33.9 months (range: 16.4-49.9), the median progression-free survival and overall survival were 16.5 months (95% CI, 6.2-26.8) and 25.6 months (95% CI, 14.6-36.6), respectively. Multivariate analyses identified that patients achieved mediastinal nodal clearance (downstage to pathological N0 or N1) after CCRT (p = 0.02) and age at diagnosis < 60 years (p = 0.01) showed significantly improved survival. Conclusion: Neoadjuvant CCRT showed a high overall response rate with tolerable toxicity profile. Downstaging after CCRT may increase the rate of complete tumor resection and result in survival benefit in stage IIIA, N2 positive NSCLC patients.

Original languageEnglish
Pages (from-to)323-330
Number of pages8
JournalLung Cancer
Volume53
Issue number3
DOIs
StatePublished - 1 Sep 2006

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Non-Small Cell Lung Carcinoma
Radiotherapy
Survival
Drug Therapy
Neoadjuvant Therapy
Esophagitis
Mortality
Paclitaxel
Neutropenia
Platinum
Disease-Free Survival
Multivariate Analysis
Radiation
Morbidity
Neoplasms

Keywords

  • Chemoradiotherapy
  • Concurrent
  • Neoadjuvant
  • Non-small cell lung cancer
  • Stage IIIA

Cite this

Park, Byeong Bae ; Park, Joon Oh ; Kim, Hojoong ; Ahn, Yong Chan ; Choi, Yong Soo ; Kim, Kwhanmien ; Kim, Jhingook ; Shim, Young Mog ; Ahn, Jin Seok ; Park, Keunchil. / Is trimodality approach better then bimodality in stage IIIA, N2 positive non-small cell lung cancer?. In: Lung Cancer. 2006 ; Vol. 53, No. 3. pp. 323-330.
@article{80ba2bc76e5442bb97b12b46d7598bb9,
title = "Is trimodality approach better then bimodality in stage IIIA, N2 positive non-small cell lung cancer?",
abstract = "Background: Neoadjuvant treatment followed by surgery is currently being investigated for locally advanced non-small cell lung cancer (NSCLC). This study reports efficacy, toxicity and feasibility of neoadjuvant chemotherapy with concurrent radiotherapy (CCRT) in stage IIIA, N2 positive NSCLC. Methods: From March 2001 to February 2004, 52 patients with histologically confirmed stage IIIA, N2 positive NSCLC were registered. Patients received preoperative CCRT that consisted of weekly paclitaxel plus platinum chemotherapy and concurrent radiotherapy followed by surgery. Results: Overall response rate was 76.9{\%} (95{\%} CI, 64-88{\%}). The major grade 3-4 toxicities were radiation esophagitis (15.4{\%}) and neutropenia (11.5{\%}), and treatment-related mortality rate was 1.9{\%}. Forty-two of 52 patients (80.8{\%}) subsequently underwent surgical resection and 35 of 52 patients (67.3{\%}) underwent complete resection. Among them, pathological complete response was obtained in 4.8{\%}. Pathological downstaging rate to N0-1 and stage 0-II at surgery were 69.0{\%} and 66.7{\%}, respectively. The perioperative major morbidity rate was 23.8{\%} and perioperative mortality was 2.4{\%}. At a median follow-up of 33.9 months (range: 16.4-49.9), the median progression-free survival and overall survival were 16.5 months (95{\%} CI, 6.2-26.8) and 25.6 months (95{\%} CI, 14.6-36.6), respectively. Multivariate analyses identified that patients achieved mediastinal nodal clearance (downstage to pathological N0 or N1) after CCRT (p = 0.02) and age at diagnosis < 60 years (p = 0.01) showed significantly improved survival. Conclusion: Neoadjuvant CCRT showed a high overall response rate with tolerable toxicity profile. Downstaging after CCRT may increase the rate of complete tumor resection and result in survival benefit in stage IIIA, N2 positive NSCLC patients.",
keywords = "Chemoradiotherapy, Concurrent, Neoadjuvant, Non-small cell lung cancer, Stage IIIA",
author = "Park, {Byeong Bae} and Park, {Joon Oh} and Hojoong Kim and Ahn, {Yong Chan} and Choi, {Yong Soo} and Kwhanmien Kim and Jhingook Kim and Shim, {Young Mog} and Ahn, {Jin Seok} and Keunchil Park",
year = "2006",
month = "9",
day = "1",
doi = "10.1111/j.1463-1318.2006.00949.x",
language = "English",
volume = "53",
pages = "323--330",
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}

Park, BB, Park, JO, Kim, H, Ahn, YC, Choi, YS, Kim, K, Kim, J, Shim, YM, Ahn, JS & Park, K 2006, 'Is trimodality approach better then bimodality in stage IIIA, N2 positive non-small cell lung cancer?', Lung Cancer, vol. 53, no. 3, pp. 323-330. https://doi.org/10.1111/j.1463-1318.2006.00949.x

Is trimodality approach better then bimodality in stage IIIA, N2 positive non-small cell lung cancer? / Park, Byeong Bae; Park, Joon Oh; Kim, Hojoong; Ahn, Yong Chan; Choi, Yong Soo; Kim, Kwhanmien; Kim, Jhingook; Shim, Young Mog; Ahn, Jin Seok; Park, Keunchil.

In: Lung Cancer, Vol. 53, No. 3, 01.09.2006, p. 323-330.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Is trimodality approach better then bimodality in stage IIIA, N2 positive non-small cell lung cancer?

AU - Park, Byeong Bae

AU - Park, Joon Oh

AU - Kim, Hojoong

AU - Ahn, Yong Chan

AU - Choi, Yong Soo

AU - Kim, Kwhanmien

AU - Kim, Jhingook

AU - Shim, Young Mog

AU - Ahn, Jin Seok

AU - Park, Keunchil

PY - 2006/9/1

Y1 - 2006/9/1

N2 - Background: Neoadjuvant treatment followed by surgery is currently being investigated for locally advanced non-small cell lung cancer (NSCLC). This study reports efficacy, toxicity and feasibility of neoadjuvant chemotherapy with concurrent radiotherapy (CCRT) in stage IIIA, N2 positive NSCLC. Methods: From March 2001 to February 2004, 52 patients with histologically confirmed stage IIIA, N2 positive NSCLC were registered. Patients received preoperative CCRT that consisted of weekly paclitaxel plus platinum chemotherapy and concurrent radiotherapy followed by surgery. Results: Overall response rate was 76.9% (95% CI, 64-88%). The major grade 3-4 toxicities were radiation esophagitis (15.4%) and neutropenia (11.5%), and treatment-related mortality rate was 1.9%. Forty-two of 52 patients (80.8%) subsequently underwent surgical resection and 35 of 52 patients (67.3%) underwent complete resection. Among them, pathological complete response was obtained in 4.8%. Pathological downstaging rate to N0-1 and stage 0-II at surgery were 69.0% and 66.7%, respectively. The perioperative major morbidity rate was 23.8% and perioperative mortality was 2.4%. At a median follow-up of 33.9 months (range: 16.4-49.9), the median progression-free survival and overall survival were 16.5 months (95% CI, 6.2-26.8) and 25.6 months (95% CI, 14.6-36.6), respectively. Multivariate analyses identified that patients achieved mediastinal nodal clearance (downstage to pathological N0 or N1) after CCRT (p = 0.02) and age at diagnosis < 60 years (p = 0.01) showed significantly improved survival. Conclusion: Neoadjuvant CCRT showed a high overall response rate with tolerable toxicity profile. Downstaging after CCRT may increase the rate of complete tumor resection and result in survival benefit in stage IIIA, N2 positive NSCLC patients.

AB - Background: Neoadjuvant treatment followed by surgery is currently being investigated for locally advanced non-small cell lung cancer (NSCLC). This study reports efficacy, toxicity and feasibility of neoadjuvant chemotherapy with concurrent radiotherapy (CCRT) in stage IIIA, N2 positive NSCLC. Methods: From March 2001 to February 2004, 52 patients with histologically confirmed stage IIIA, N2 positive NSCLC were registered. Patients received preoperative CCRT that consisted of weekly paclitaxel plus platinum chemotherapy and concurrent radiotherapy followed by surgery. Results: Overall response rate was 76.9% (95% CI, 64-88%). The major grade 3-4 toxicities were radiation esophagitis (15.4%) and neutropenia (11.5%), and treatment-related mortality rate was 1.9%. Forty-two of 52 patients (80.8%) subsequently underwent surgical resection and 35 of 52 patients (67.3%) underwent complete resection. Among them, pathological complete response was obtained in 4.8%. Pathological downstaging rate to N0-1 and stage 0-II at surgery were 69.0% and 66.7%, respectively. The perioperative major morbidity rate was 23.8% and perioperative mortality was 2.4%. At a median follow-up of 33.9 months (range: 16.4-49.9), the median progression-free survival and overall survival were 16.5 months (95% CI, 6.2-26.8) and 25.6 months (95% CI, 14.6-36.6), respectively. Multivariate analyses identified that patients achieved mediastinal nodal clearance (downstage to pathological N0 or N1) after CCRT (p = 0.02) and age at diagnosis < 60 years (p = 0.01) showed significantly improved survival. Conclusion: Neoadjuvant CCRT showed a high overall response rate with tolerable toxicity profile. Downstaging after CCRT may increase the rate of complete tumor resection and result in survival benefit in stage IIIA, N2 positive NSCLC patients.

KW - Chemoradiotherapy

KW - Concurrent

KW - Neoadjuvant

KW - Non-small cell lung cancer

KW - Stage IIIA

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U2 - 10.1111/j.1463-1318.2006.00949.x

DO - 10.1111/j.1463-1318.2006.00949.x

M3 - Article

C2 - 16844258

AN - SCOPUS:33746903555

VL - 53

SP - 323

EP - 330

JO - Lung Cancer

JF - Lung Cancer

SN - 0169-5002

IS - 3

ER -