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Comparative Study
. 2012 Sep;94(3):914-20.
doi: 10.1016/j.athoracsur.2012.04.088. Epub 2012 Jul 21.

The role of consolidation therapy for stage III non-small cell lung cancer with persistent N2 disease after induction chemotherapy

Arya Amini  1 , Arlene M Correa, Ritsuko Komaki, Joe Y Chang, Anne S Tsao, Jack A Roth, Stephen G Swisher, David C Rice, Ara A Vaporciyan, Steven H Lin
Affiliations
Comparative Study

The role of consolidation therapy for stage III non-small cell lung cancer with persistent N2 disease after induction chemotherapy

Arya Amini et al. Ann Thorac Surg. 2012 Sep.

Abstract

Background: Persistent pathologic mediastinal nodal involvement after induction chemotherapy and surgical resection is a negative prognostic factor for stage III-N2 non-small cell lung cancer patients. This population has high rates of local-regional failure and distant failure, yet the effectiveness of additional therapies is not clear. We assessed the role of consolidative therapies (postoperative radiation therapy and chemotherapy) for such patients.

Methods: In all, 179 patients with stage III-N2 non-small cell lung cancer at MD Anderson Cancer Center were treated with induction chemotherapy followed by surgery from 1998 through 2008; 61 patients in this cohort had persistent, pathologically confirmed, mediastinal nodal disease, and were treated with postoperative radiation therapy. Local-regional failure was defined as recurrence at the surgical site or lymph nodes (levels 1 to 14, including supraclavicular), or both. Overall survival was calculated using the Kaplan-Meier method, and survival outcomes were assessed by log rank tests. Univariate and multivariate Cox proportional hazards models were used to identify factors influencing local-regional failure, distant failure, and overall survival.

Results: All patients received postoperative radiation therapy after surgery, but approximately 25% of the patients also received additional chemotherapy: 9 (15%) with concurrent chemotherapy, 4 (7%) received adjuvant sequential chemotherapy, and 2 (3%) received both. Multivariate analysis indicated that additional postoperative chemotherapy significantly reduced distant failure (hazard ratio 0.183, 95% confidence interval: 0.052 to 0.649, p=0.009) and improved overall survival (hazard ratio 0.233, 95% confidence interval: 0.089 to 0.612, p=0.003). However, additional postoperative chemotherapy had no affect on local-regional failure.

Conclusions: Aggressive consolidative therapies may improve outcomes for patients with persistent N2 disease after induction chemotherapy and surgery.

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Figures

Fig 1
Fig 1
Kaplan-Meier curves illustrating (A) cumulative locoregional (LR)-free probability, (B) cumulative distant metastasis (DM)-free recurrence, and (C) cumulative overall survival (OS) with postoperative chemotherapy (chemo) versus without postoperative chemotherapy.
See this image and copyright information in PMC

Comment in

  • Invited commentary.
    D'Amico TA. D'Amico TA. Ann Thorac Surg. 2012 Sep;94(3):920-1. doi: 10.1016/j.athoracsur.2012.05.076. Ann Thorac Surg. 2012. PMID: 22916752 No abstract available.
  • Current readings: management of N2 disease for lung cancer.
    Wigle DA. Wigle DA. Semin Thorac Cardiovasc Surg. 2014 Spring;26(1):67-70. doi: 10.1053/j.semtcvs.2014.02.008. Epub 2014 Feb 27. Semin Thorac Cardiovasc Surg. 2014. PMID: 24952759

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