Concurrent chemo-radiation results in equivalent local and overall outcome as induction chemotherapy followed by surgery for clinical stage IIIA non-small cell lung cancer

Purpose/Objective: To compare the outcome of treatment with induction chemotherapy followed by surgery, or treatment with concurrent chemo-radiation, for patients with clinical stage IIIA non-small cell lung cancer (NSCLC).Materials/Methods: From 1990 to 1999, 107 patients were treated either with induction chemotherapy followed by surgery (C/S, 55 patients) or with concurrent chemo-radiation (CRT, 52 patients) for clinical stage IIIA NSCLC at the University of Texas M.D. Anderson Cancer Center. Patient and tumor characteristics were balanced in the two treatment groups with respect to T-stage and N-stage (T2N2=22-C/S, 31-CRT; T3N1=12-C/S, 9-CRT; T3N2=21-C/S, 12-CRT; p=NS), sex (male=30 C/S, 31 CRT; female=25 C/S, 21 CRT; p=NS), race (white=45 C/S, 47 CRT; black=1 C/S, 3 CRT; hispanic=9 C/S, 1 CRT; other=0 C/S, 1 CRT; p=NS), median age (58 C/S, 64 CRT; p=NS), performance status, weight loss, and histology (adenocarcinoma=27 C/S, 11 CRT; squamous=21 C/S, 15 CRT; large cell=7 C/S, 5 CRT; unspecified NSCLC=0 C/S, 21 CRT; p=NS). Staging work-up included chest X-ray, chest CT, Abdominal CT, brain CT, and bone scan. Mediastinoscopy was not routinely performed in either group. In the C/S group, induction chemotherapy included 2-4 cycles of cisplatin based chemotherapy followed by lobectomy and mediastinal lymph node dissection. Post-operative radiotherapy was delivered in 35 patients, with referral for radiotherapy at the discretion of the treating physician. CRT consisted of three cycles of cisplatin based chemotherapy q3weeks concurrent with XRT to 60-63 Gy/30-35 fx in 27 patients, or to 69.6Gy/58fx(bid) in 25 patients. Rates of local control (LC), overall survival (OS), disease-free survival (DFS), and distant-metastasis free survival (DMS) were calculated with Kaplan-Meier methodology. Median follow-up was 20 months in all patients, and 32 months in surviving patients.Results: Overall, median survival (31 months-C/S, 27 months-CRT, p=NS) and 5-year OS (33%-C/S, 30%-CRT, p=NS) were not significantly different among the two treatment groups. Likewise, 5-year DFS (24%-C/S, 23%-CRT p=NS) and 5-year LC (58%-C/S, 61%-CRT, p=NS) and 5-year DMS (44%-C/S, 36%-CRT, p=NS) were not significantly different between the two treatment groups. Among patients treated with C/S, post-operative radiotherapy significantly improved 5-year LC from 33.8% to 81.5%, p=0.007, but did not significant improve overall survival. Additionally, patients who responded to induction chemotherapy in the C/S group had significantly improved 5-year overall survival (50%) vs. those who had stable or progressive disease (16%), p=0001.Conclusions: Patients with clinical stage IIIA NSCLC have equivalent survival and local control following treatment with either chemotherapy followed by surgery or with concurrent chemo-radiation. Post-operative XRT significantly improves LC in patients treated with C/S, without improving OS. Purpose/Objective: To compare the outcome of treatment with induction chemotherapy followed by surgery, or treatment with concurrent chemo-radiation, for patients with clinical stage IIIA non-small cell lung cancer (NSCLC). Materials/Methods: From 1990 to 1999, 107 patients were treated either with induction chemotherapy followed by surgery (C/S, 55 patients) or with concurrent chemo-radiation (CRT, 52 patients) for clinical stage IIIA NSCLC at the University of Texas M.D. Anderson Cancer Center. Patient and tumor characteristics were balanced in the two treatment groups with respect to T-stage and N-stage (T2N2=22-C/S, 31-CRT; T3N1=12-C/S, 9-CRT; T3N2=21-C/S, 12-CRT; p=NS), sex (male=30 C/S, 31 CRT; female=25 C/S, 21 CRT; p=NS), race (white=45 C/S, 47 CRT; black=1 C/S, 3 CRT; hispanic=9 C/S, 1 CRT; other=0 C/S, 1 CRT; p=NS), median age (58 C/S, 64 CRT; p=NS), performance status, weight loss, and histology (adenocarcinoma=27 C/S, 11 CRT; squamous=21 C/S, 15 CRT; large cell=7 C/S, 5 CRT; unspecified NSCLC=0 C/S, 21 CRT; p=NS). Staging work-up included chest X-ray, chest CT, Abdominal CT, brain CT, and bone scan. Mediastinoscopy was not routinely performed in either group. In the C/S group, induction chemotherapy included 2-4 cycles of cisplatin based chemotherapy followed by lobectomy and mediastinal lymph node dissection. Post-operative radiotherapy was delivered in 35 patients, with referral for radiotherapy at the discretion of the treating physician. CRT consisted of three cycles of cisplatin based chemotherapy q3weeks concurrent with XRT to 60-63 Gy/30-35 fx in 27 patients, or to 69.6Gy/58fx(bid) in 25 patients. Rates of local control (LC), overall survival (OS), disease-free survival (DFS), and distant-metastasis free survival (DMS) were calculated with Kaplan-Meier methodology. Median follow-up was 20 months in all patients, and 32 months in surviving patients. Results: Overall, median survival (31 months-C/S, 27 months-CRT, p=NS) and 5-year OS (33%-C/S, 30%-CRT, p=NS) were not significantly different among the two treatment groups. Likewise, 5-year DFS (24%-C/S, 23%-CRT p=NS) and 5-year LC (58%-C/S, 61%-CRT, p=NS) and 5-year DMS (44%-C/S, 36%-CRT, p=NS) were not significantly different between the two treatment groups. Among patients treated with C/S, post-operative radiotherapy significantly improved 5-year LC from 33.8% to 81.5%, p=0.007, but did not significant improve overall survival. Additionally, patients who responded to induction chemotherapy in the C/S group had significantly improved 5-year overall survival (50%) vs. those who had stable or progressive disease (16%), p=0001. Conclusions: Patients with clinical stage IIIA NSCLC have equivalent survival and local control following treatment with either chemotherapy followed by surgery or with concurrent chemo-radiation. Post-operative XRT significantly improves LC in patients treated with C/S, without improving OS.