The Outcomes of Induction Chemoradiotherapy Followed by Surgery for Clinical T3-4 Non-Small Cell Lung Cancer

Abstract

Purpose: Information on the short- and long-term outcomes of induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer is limited. We analyzed the short- and long-term outcomes of induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer.

Methods: Patients with non-small cell lung cancer who underwent induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer were retrospectively reviewed (initial treatment group, n = 31). Their results were compared to those patients who underwent surgery as an initial treatment during the same period (initial surgery group, n = 35).

Results: Downstaging was achieved in 14 (45%) patients in the initial treatment group. R0 resection was achieved in 28 (90%) patients in the initial treatment group and 31 (88%) patients in the initial surgery group. The 90-day mortality rate was 3% in each group. Postoperative complications occurred in 16 (52%) patients in the initial treatment group and 13 (37%) patients in the initial surgery group. The 5-year overall survival rate of the initial treatment group was significantly higher than that of the initial surgery group (62.6% vs 43.5%, P = .04). The 5-year overall survival rates of the initial treatment N0-1 group and the initial surgery N0-1 group were 88.9% and 49.3%, respectively; the difference was statistically significant (P = .02). Multivariate analysis using 4 factors (age [≤65 vs >65], cN [cN0-1 vs cN2], general condition [chemoradiotherapy fit vs chemoradiotherapy unfit], and treatment mode [induction chemoradiotherapy followed by surgery vs surgery as an initial treatment]) revealed that treatment mode (induction chemoradiotherapy followed by surgery) and cN status (cN0-1) were significantly associated with good overall survival and disease-free survival.

Conclusions: Induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer could be performed with an acceptable degree of surgical risk. At present, it is thought to be one of the reasonable treatment approaches for selected patients with cT3-4 disease, even those with a cN0-1 status.

Keywords: chemoradiotherapy; non-small cell lung cancer; surgery.

Figure 1.

Kaplan-Meier plots of overall survival rate according to the resectability which is determined before treatment by radiological examinations. The 5-year overall survival rate of resectable or marginally resectable patients were significantly higher than that of unresectable patients (54.3% vs 32.4%, P = .01).

Figure 2.

Kaplan-Meier plots of the overall survival rates according to treatment mode. The 5-year overall survival rates of patients who underwent surgery as an initial treatment, induction CRT followed by surgery, definitive CRT, induction CT followed by surgery, and RT alone were 43.6%, 62.6%, 49.2%, 58.0%, and 12.9%, respectively. CRT indicates chemoradiotherapy.

Figure 3.

(Upper) Kaplan-Meier plots of the disease-free survival rates of the initial treatment (IT) and Initial Surgery (IS) groups. The 5-year disease-free survival rates of the IT and IS groups were 59.6% and 36.3%, respectively (P = .10). (Lower) Kaplan-Meier plots of the overall survival rates of the IT and IS groups. The 5-year overall survival rates of the IT and IS groups were 62.6% and 43.5%, respectively; the difference was statistically significant (P = .04).

Figure 4.

(Upper) Kaplan-Meier plots of the disease-free survival rates of the initial treatment (IT) N0-1 and Initial Surgery (IS) N0-1 groups. The 5-year disease-free survival rates of the IT N0-1 group and the IS N0-1 group were 88.9% and 42.4%, respectively; the difference was statistically significant (P = .02). (Lower) Kaplan-Meier plots of the overall survival rates of the IT N0-1 and IS N0-1 groups. The 5-year overall survival rates of the IT N0-1 and the IS N0-1 groups were 88.9% and 49.3%, respectively; the difference was statistically significant (P = .02).

Figure 5.

(Upper) Kaplan-Meier plots of the overall survival rates of the initial treatment (IT) N0-1 and Initial Surgery (IS) N0-1 “induction CRT-fit” groups. The 5-year overall survival rates of the IT N0-1 and IS N0-1 “induction CRT-fit” groups were 88.9% and 41.7%, respectively; the difference was statistically significant (P = .01). (Lower) Kaplan-Meier plots of the overall survival rates of the IT N0-1 and IS N0-1 “induction CRT-fit” groups. The 5-year overall survival rates of the IT N0-1 group and the IS N0-1 “induction CRT-fit” group were 88.9% and 50.0%, respectively; the difference was statistically significant (P = .01).