Definitive Bimodality Concurrent Chemoradiotherapy in Patients with Inoperable N2-positive Stage IIIA Non-small Cell Lung Cancer
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Purpose This study was conducted to evaluate the treatment outcomes following definitive bimodalityconcurrent chemoradiotherapy (CCRT) in patients with inoperable N2-positive stage IIIA (N2-IIIA) non-small cell lung cancer (NSCLC). Materials and MethodsFrom May 1997 to December 2012, 65 out of 633 patients with N2-IIIA NSCLC receivedbimodality therapy. The treatment modality was selected during/after neoadjuvant CCRTin 21 patients or primarily at diagnosis in 44 through a multidisciplinary consensus meeting. The median age was 65 years (range, 36 to 76 years). Sixty patients (92.3%) had clinicallyevident N2 disease, while 22 (33.8%) had multi-station N2 involvement. The median radiationtherapy dose was 66 Gy in 33 fractions, while the dose was elevated to 72 Gy in 13patients who had a treatment break due to delayed decision regarding resectability. Themost frequent chemotherapy regimen was weekly paclitaxel or docetaxel plus cisplatin orcarboplatin (54, 83.1%). ResultsDuring the median follow-up of 18.8 months (range, 1.6 to 173.1 months), 34 patients(52.3%) experienced disease progression, with distant metastasis being the most commonfirst treatment failure pattern (23, 34.8%). The median and 2-year rates of progression-freesurvival were 18.8 months and 45.9%, respectively. The median and 2-year rates of overallsurvival were 28.6 months and 50.1%, respectively. ConclusionDefinitive bimodality therapy in patients with N2-IIIA NSCLC demonstrated favorable outcomes,while trimodality therapy could be considered for candidates for less than pneumonectomy.
Abstract
Purpose This study was conducted to evaluate the treatment outcomes following definitive bimodalityconcurrent chemoradiotherapy (CCRT) in patients with inoperable N2-positive stage IIIA (N2-IIIA) non-small cell lung cancer (NSCLC). Materials and MethodsFrom May 1997 to December 2012, 65 out of 633 patients with N2-IIIA NSCLC receivedbimodality therapy. The treatment modality was selected during/after neoadjuvant CCRTin 21 patients or primarily at diagnosis in 44 through a multidisciplinary consensus meeting. The median age was 65 years (range, 36 to 76 years). Sixty patients (92.3%) had clinicallyevident N2 disease, while 22 (33.8%) had multi-station N2 involvement. The median radiationtherapy dose was 66 Gy in 33 fractions, while the dose was elevated to 72 Gy in 13patients who had a treatment break due to delayed decision regarding resectability. Themost frequent chemotherapy regimen was weekly paclitaxel or docetaxel plus cisplatin orcarboplatin (54, 83.1%). ResultsDuring the median follow-up of 18.8 months (range, 1.6 to 173.1 months), 34 patients(52.3%) experienced disease progression, with distant metastasis being the most commonfirst treatment failure pattern (23, 34.8%). The median and 2-year rates of progression-freesurvival were 18.8 months and 45.9%, respectively. The median and 2-year rates of overallsurvival were 28.6 months and 50.1%, respectively. ConclusionDefinitive bimodality therapy in patients with N2-IIIA NSCLC demonstrated favorable outcomes,while trimodality therapy could be considered for candidates for less than pneumonectomy.
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