Induction chemoradiotherapy versus chemotherapy alone for superior sulcus lung cancer. (August 2018)

• Record Type: Journal Article
• Authors: Robinson, Lary A.; Tanvetyanon, Tawee; Grubbs, Deanna; Antonia, Scott; Creelan, Ben; Fontaine, Jacques; Toloza, Eric; Keenan, Robert; Dilling, Thomas; Stevens, Craig W.; Sommers, K. Eric; Vrionis, Frank
• Is Part Of: Lung cancer. Volume 122(2018)
• Page Start: 206
• Page End: 213
• Publication Date: 2018-08
• Subjects: ASA American Society of Anesthesiologists physical status classification system -- cGy centigray -- Ch chemotherapy only -- CI confidence interval -- CRT concurrent chemoradiotherapy -- CR complete response -- CT computed tomography -- DFI disease free interval -- FEV1 forced expiratory volume in one second (liters or % of predicted) -- Fig figure -- Gy gray -- HR hazard ratio -- INT Intergroup -- IRB institutional review board -- MRI magnetic resonance imaging -- N number of patients -- N0 all lymph nodes negative for metastatic disease -- N1 lobar or hilar lymph nodes positive for metastatic disease -- N2 ipsilateral mediastinal lymph nodes positive for metastatic disease -- N3 contralateral mediastinal or supraclavicular lymph nodes positive for metastatic disease -- NSCLC non-small cell lung cancer -- PET positron emission tomography -- PR partial response -- R0 complete gross surgical resection with microscopically negative margins -- R1 complete gross surgical resection with microscopically positive margins -- R2 surgical resection with a grossly positive margin verified by pathologic evaluation -- SD standard deviation -- T3 tumor invading chest wall including ribs (just for the purpose of this study). Additional qualifiers apply -- T4 tumor invading vertebral body or great vessels (just for the purpose of this study). Additional qualifiers apply; Superior sulcus tumor -- Pancoast tumor -- Induction therapy -- Non-small cell lung cancer -- Thoracic surgery; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2018.06.021
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Induction chemotherapy only may provide comparable outcomes to chemoradiotherapy. Impaired performance status patients may tolerate induction chemotherapy better. Induction therapy of some type offers improved results over initial surgery alone. Sublobar resection is an acceptable alternative when lobectomy is not feasible. Multimodality treatment involving experienced thoracic surgeons is advocated. Abstract: Objectives: Although treatment of superior sulcus tumors with induction chemoradiotherapy (CRT ) followed by surgery employed in the Intergroup INT-0160 trial is widely adopted as a standard of care, there may be significant associated morbidity and mortality. We describe our experience using standard and alternative induction regimens to assess survival rates and treatment toxicity in these patients. Materials and methods: Electronic medical records of all patients who underwent multimodality treatment including resection of lung cancer invading the superior pulmonary sulcus between 1994 and 2016 were retrospectively reviewed. Multivariable Cox Proportional Hazards model was constructed. Results: Of 102 consecutive patients, 53 (52%) underwent induction CRT, 34 (33%) underwent induction chemotherapy only (Ch ) followed by adjuvant radiotherapy, and 15 (15%) underwent no induction therapy followed by adjuvant therapy. There were 2 postoperative deaths (1.9%). To date, 42 patients are alive with a median follow-up 72.5 months. Overall 5-year survival rate was 45.4%. Survival was significantly influenced by age, FEV1, positive resection margins, surgical complications, but not the induction regimen. CRT resulted in higher complete pathological response rate than Ch : 38% vs. 3% ( p < 0.001). CRT was associated with higher post-operative re-intubation rate: 13% vs. 0% ( p = 0.03). Conclusions: Our single-institutional experience indicated that while induction CRT produced greater complete pathological response than Ch, it also increased the risk of post-operative complications. With careful patient selection, induction Ch followed by adjuvant radiotherapy may provide comparable survival outcomes to induction CRT . Since induction Ch is associated with lower risk of complications, it may be a particularly desirable choice for patients with impaired performance status.