Stage IIIA non-small cell lung cancer: Morbidity and mortality of three distinct multimodality regimens

Christopher W. Seder, Mark S. Allen, Stephen D. Cassivi, Claude Deschamps, Francis C. Nichols, Kenneth R. Olivier, K. Robert Shen, Dennis A. Wigle

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19 Scopus citations

Abstract

Background: Although concurrent chemoradiation therapy can cure stage IIIA non-small cell lung cancer (NSCLC), studies have demonstrated that anatomic resection following high-dose or standard-dose chemoradiation may benefit selected patients. We examined morbidity and mortality associated with 3 multimodality treatment regimens for stage IIIA disease. Methods: Institutional databases identified patients with stage IIIA (N2) NSCLC who underwent concurrent platinum-based chemoradiotherapy with or without pulmonary resection between 1998 and 2011. Exclusion criteria included palliative regimens, sequential chemoradiotherapy, radiation-surgery interval greater than 12 weeks, superior sulcus tumors, or radiotherapy other than standard external beam radiation. Treatment-related morbidity and mortality were examined for the following treatment regimens: neoadjuvant chemoradiotherapy with 45 Gy followed by surgery (trimodality-45); neoadjuvant chemoradiotherapy with 60 Gy or more followed by surgery (trimodality-60); and definitive chemoradiotherapy with 60 Gy or more without surgery (D-CRT). Results: During the study period, 144 patients met eligibility criteria including 27 trimodality-45, 29 trimodality-60, and 88 D-CRT patients. Treatment-related morbidity and mortality rates for D-CRT were 74% [65 of 88] and 2.3% [2 of 88], respectively. Postoperative morbidity and mortality rates for patients who proceeded to surgery were 48% [27 of 56] and 1.8% [1 of 56], respectively, and did not differ based on dose of neoadjuvant radiation. Despite varied anatomic resections and methods of bronchial closure and coverage, no bronchopleural fistulae were observed. Conclusions: Chemoradiotherapy carries a significant morbidity profile. However, high-dose neoadjuvant radiation is not associated with increased postoperative morbidity or mortality relative to standard-dose radiation in patients selected for anatomic resection.

Original languageEnglish (US)
Pages (from-to)1708-1716
Number of pages9
JournalAnnals of Thoracic Surgery
Volume95
Issue number5
DOIs
StatePublished - May 1 2013

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Seder, C. W., Allen, M. S., Cassivi, S. D., Deschamps, C., Nichols, F. C., Olivier, K. R., Shen, K. R., & Wigle, D. A. (2013). Stage IIIA non-small cell lung cancer: Morbidity and mortality of three distinct multimodality regimens. Annals of Thoracic Surgery, 95(5), 1708-1716. https://doi.org/10.1016/j.athoracsur.2013.02.041