dc.contributor.author |
Couñago Lorenzo, Felipe |
|
dc.contributor.author |
Montemuiño, Sara |
|
dc.contributor.author |
Jové Teixidó, Josep |
|
dc.contributor.author |
Taboada, Begoña |
|
dc.contributor.author |
Calvo Crespo, Patricia |
|
dc.contributor.author |
Martín, Margarita |
|
dc.contributor.author |
López Mata, Miriam |
|
dc.contributor.author |
Samper Ots, María Pilar |
|
dc.contributor.author |
Cerro, Elia del |
|
dc.contributor.author |
Rodríguez de Dios, Nuria |
|
dc.contributor.author |
Et al. |
|
dc.date.accessioned |
2021-01-27T14:31:06Z |
|
dc.date.available |
2021-01-27T14:31:06Z |
|
dc.date.issued |
2017 |
|
dc.identifier.citation |
Couñago, F., Montemuino Muñíz, S., Jové-Teixidó, J., Taboada, B., Calvo-Crespo, P., Martín, M., López, M., Samper Ots, P. M., Cerro, E. del, López, J., García Canivano, T., Díaz, V., Ingunza Barón, L. de, Murcia, M., Alcántara, M., Corona, J., Puertas, M. M., Chust, M., Couselo, M. L., & Rodríguez de Dios, N. (2017). Neoadjuvant Treatment Followed by Surgery Versus Chemoradiation in Stage IIIA-N2 Non–small Cell Lung Cancer on Behalf of GOECP/SEOR-GICOR. International Journal of Radiation Oncology*Biology*Physics, 99(2, Supplement), E482–E483. https://doi.org/10.1016/j.ijrobp.2017.06.1757 |
spa |
dc.identifier.issn |
0360-3016 |
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dc.identifier.issn |
1879-355X |
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dc.identifier.uri |
http://hdl.handle.net/11268/9793 |
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dc.description.abstract |
Purpose/Objective(s)
A subset analyses of randomized intergroup trial (INT0139) published in 2009, suggested that surgery after neoadjuvant treatment in patients with stage IIIA (N2) non-small-cell lung cancer (NSCLC) may increase the survival. Due to the difficulty in recruiting this subset of patients in clinical trials, we have designed a retrospective multicenter observational study to compare neoadjuvant treatment based on chemoradiation or chemotherapy followed by surgery (CRTS) with definitive chemoradiation (CRT).
Materials/Methods
297 NSCLC patients with stage T1-T3N2M0 underwent CRTS or CRT between January 2005 and December 2014, in 15 hospitals in Spain. In both arms, chemotherapy was platinum-based. Minimum radiation dose was 45 Gy in the CRTS group and 60 Gy in the CRT group. It was delivered in daily fractions of 1.8-2 Gy/day, with 3D conformal radiotherapy (N=237), intensity modulated radiation therapy (N=3) or volumetric modulated arc therapy (N=5). Patient and tumor characteristics were balanced by propensity score analysis method. The primary endpoint was overall survival (OS).
Results
117 patients (median age 62 years, range 41-78) were treated with CRTS and 180 patients (65 years, range 37-82) with definitive CRT. Comparing CRTS with CRT patients, performance status was 0-1 in 99.1% vs. 97.2%; 60.6% vs. 64.4% were T1 or T2 tumors, (p=0.014); 38.4% vs. 57.2% presented two or more positive nodal stations (p=0.005); and 6.8% vs. 14.4% showed a positive nodal size ≥ 3 cm (p=0.044). Histopathological confirmation of mediastinal lymph nodes was performed in 58.1% and 65% patients, respectively. In CRTS group, 52.13% patients were treated with neoadjuvant CRT and 82.0% underwent lobectomy.
Median follow-up was 27 months (43 months in CRTS and 23 months in CRT). Median OS was 58 months in CRTS vs. 27 months in CRT (hazard ratio [HR] 0.36, 95% CI: 0.23-0.56; p<0.001) after propensity score adjustment. Lobectomy vs. neumonectomy, (111 vs. 35 months, p=0.004), pT0-T2 status vs. pT3-T4 (111 vs. 22 months, p<0.001), doses ≥60 Gy vs. <60 Gy (25 vs. 14 months, p=0.001) and no treatment interruptions or interruptions ≤1 week vs. >1 week, (37 vs. 30 months, p=0.03), were associated with higher OS in a regression analisys. Progression-free survival (PFS) was better in CRTS than CRT group, median 57 months vs. 14 months, HR 0.35, (95% CI 0.22-0.54; p<0.001). Although grade > 3 oesophagitis and pneumonitis were similar in both arms, grade >3 hematological toxicity was greater in CRT group (2.9% vs. 21.1%, p=0.001). Adjusted treatment-related mortality was 6.1% (2/77) in CRTS group vs. 7% (4/77) in CRT, (p=0.846).
Conclusion
Neoadjuvant chemoradiation treatment followed by surgery in stage IIIA-N2 NSCLC patients showed a better PFS and OS compared with definitive CRT patients. Furthermore, treatment-related mortality was similar in both treatment arms. |
spa |
dc.description.sponsorship |
Sin financiación |
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dc.language.iso |
eng |
spa |
dc.subject.other |
Neoplasias pulmonares |
spa |
dc.subject.other |
Quimioterapia |
spa |
dc.title |
Neoadjuvant Treatment Followed by Surgery Versus Chemoradiation in Stage IIIA-N2 Non–small Cell Lung Cancer on Behalf of GOECP/SEOR-GICOR |
spa |
dc.type |
article |
spa |
dc.description.impact |
5.554 JCR (2017) Q1, 41/223 Oncology |
spa |
dc.description.impact |
2.485 SJR (2017) Q1, 31/230 Cancer Research |
spa |
dc.description.impact |
No data IDR 2017 |
spa |
dc.identifier.doi |
10.1016/j.ijrobp.2017.06.1757 |
|
dc.rights.accessRights |
openAccess |
spa |
dc.subject.unesco |
Cáncer |
spa |
dc.subject.unesco |
Tratamiento médico |
spa |
dc.subject.unesco |
Medicamento |
spa |
dc.description.filiation |
UEM |
spa |
dc.relation.publisherversion |
https://doi.org/10.1016/j.ijrobp.2017.06.1757 |
spa |
dc.peerreviewed |
Si |
spa |