Implications of Pathologic Complete Response Beyond Mediastinal Nodal Clearance With High-Dose Neoadjuvant Chemoradiation Therapy in Locally Advanced, Non-Small Cell Lung Cancer.

Autor:	Vyfhuis MAL; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Burrows WM; Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland., Bhooshan N; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Suntharalingam M; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Donahue JM; Division of Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama., Feliciano J; Department of Hematology and Oncology, Johns Hopkins Hospital, Baltimore, Maryland., Badiyan S; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland., Nichols EM; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland., Edelman MJ; Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Carr SR; Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland., Friedberg J; Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland., Henry G; Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland., Stewart S; Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland., Sachdeva A; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland., Pickering EM; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland., Simone CB 2nd; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Feigenberg SJ; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania., Mohindra P; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland. Electronic address: pranshumohindra@gmail.com.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2018 Jun 01; Vol. 101 (2), pp. 445-452. Date of Electronic Publication: 2018 Feb 13.
DOI:	10.1016/j.ijrobp.2018.02.003
Abstrakt:	Purpose: To determine, in a retrospective analysis of a large cohort of stage III non-small cell lung cancer patients treated with curative intent at our institution, whether having a pathologic complete response (pCR) influenced overall survival (OS) or freedom from recurrence (FFR) in patients who underwent definitive (≥60 Gy) neoadjuvant doses of chemoradiation (CRT). Methods and Materials: At our institution, 355 patients with locally advanced non-small cell lung cancer were treated with curative intent with definitive CRT (January 2000-December 2013), of whom 111 underwent mediastinal reassessment for possible surgical resection. Ultimately 88 patients received trimodality therapy. Chi-squared analysis was used to compare categorical variables. The Kaplan-Meier analysis was performed to estimate OS and FFR, with Cox regression used to determine the absolute hazards. Results: Using high-dose neoadjuvant CRT, we observed a mediastinal nodal clearance (MNC) rate of 74% (82 of 111 patients) and pCR rate of 48% (37 of 77 patients). With a median follow-up of 34.2 months (range, 3-177 months), MNC resulted in improved OS and FFR on both univariate (OS: hazard ratio [HR] 0.455, 95% confidence interval [CI] 0.272-0.763, P = .004; FFR: HR 0.426, 95% CI 0.250-0.726, P = .002) and multivariate analysis (OS: HR 0.460, 95% CI 0.239-0.699, P = .001; FFR: HR 0.455, 95% CI 0.266-0.778, P = .004). However, pCR did not independently impact OS (P = .918) or FFR (P = .474). Conclusions: Mediastinal nodal clearance after CRT continues to be predictive of improved survival for patients undergoing trimodality therapy. However, a pCR at both the primary and mediastinum did not further improve survival outcomes. Future therapies should focus on improving MNC to encourage more frequent use of surgery and might justify use of preoperative CRT over chemotherapy alone. (Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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