Chemoradiation With or Without Surgery for Stage IIIA Non-Small Cell Lung Cancer (NSCLC): A Comparison of Survival and Patterns of Failure

James Metz, MD
OncoLink Associate Editor
Last Modified: November 3, 1999

Presenter: Mitchell Machtay, MD
Affiliation: University of Pennsylvania

Background:
One of the most controversial topics in the management of NSCLC is the treatment of stage IIIA disease. Chemotherapy is generally accepted as an indicated treament in patients with good performance status. The management of local disease using surgery versus radiation therapy remains controversial. This study was performed to evaluated outcomes in patients with stage IIIA NSCLC treated with definitive chemoradiation vs preoperative chemoradiation therapy. Materials and Methods:

Charts of 83 patients with NSCLC were reviewed retrospectively
83% had a mediastinoscopy to confirm N2 disease
All patients received chemoradiation therapy
The two groups were divided by intended preoperative chemoradiation followed by surgery versus definitive chemoradiation
39 patients were treated with a preoperative approach
Median follow-up in this series is 16 months

Results:

Local-regional control was better in the patients where surgery is planned (81% vs 50%)
Distant metastatic rate was 49% in both groups
Overall death from respiratory failure was 33% with no difference between the groups
Overall survival at 3 years is not different between the 2 groups
An analysis of the preoperative chemoradiation patients showed 31/39 (77%)underwent surgical resection
Toxicity and treatment related death was similar in both groups

Clinical/Scientific Implications:

There was no difference in survival between the 2 groups
There was increased local-regional control in the surgical group, although it must be remembered this is a selected group of patients
It is clear that improvements in systemic control are needed to improve overall survival in patients with stage IIIA NSCLC
It is recommended that patients continue to be enrolled in RTOG 93-09 protocol to identify the most appropriate treatment for stage IIIA NSCLC

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