Resection following concurrent chemotherapy and high-dose radiation for stage IIIA non-small cell lung cancer

• Type of Material: Article
• Authors: Jessica S Donington, NYU School of Medicine; Rebecca Paulus, NRG Oncology Statistics and Data Management Center; Martin J Edelman, University of Maryland; Mark J Krasna, Jersey Shore University Medical Center; Quynh-Thu Le, Stanford Cancer Institute; Mohan Suntharalingam, University of Maryland; Billy W Loo, Stanford Cancer Institute; Chen Hu, NRG Oncology Statistics and Data Management Center; Jeffrey Bradley, Emory University
• Language: English
• Date: 2020-11-01
• Publisher: MOSBY-ELSEVIER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jtcvs.2020.03.171
• Title of Journal or Parent Work: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
• Volume: 160
• Issue: 5
• Start Page: 1331
• End Page: +
• Grant/Funding Information: This project was supported by grants U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology SDMC), U24CA180803 (IROC) from the National Cancer Institute (NCI) and Amgen.
• Keywords: Cardiovascular System & Cardiology; surgery; RADIOTHERAPY; Surgery; lung cancer; Life Sciences & Biomedicine; RANDOMIZED TRIAL; INDUCTION CHEMORADIATION; CARBOPLATIN; SURGICAL RESECTION; induction therapy; Respiratory System; radiation; THORACIC RADIATION; SURGERY; chemotherapy; Science & Technology; PHASE-II; Cardiac & Cardiovascular Systems; PULMONARY RESECTION; NEOADJUVANT CHEMORADIATION
• Research Categories: Statistics

Abstract

Objective: Concern exists regarding surgery after thoracic radiation. We aimed to assess early results of anatomic resection following induction therapy with platinum-based chemotherapy and full-dose thoracic radiation for resectable N2+ stage IIIA non–small cell lung cancer. Methods: Two prospective trials were recently conducted by NRG Oncology in patients with resectable N2+ stage IIIA non–small cell lung cancer with the primary end point of mediastinal node sterilization following concurrent full-dose chemoradiotherapy (Radiation Therapy Oncology Group trials 0229 and 0839). All surgeons demonstrated postinduction resection expertise. Induction consisted of weekly carboplatin (area under the curve, 2.0) and paclitaxel (50 mg/m2) and concurrent thoracic radiation 60 Gy (0839)/61.2 Gy (0229) in 30 fractions. Patients in study 0839 were randomized 2:1 to weekly panitumumab + chemoradiotherapy or chemoradiotherapy alone during induction. Primary results were similar in all treatment arms and reported previously. Short-term surgical outcomes are reported here. Results: One hundred twenty-six patients enrolled; 93 (74%) had anatomic resection, 77 underwent lobectomy, and 16 underwent extended resection. Microscopically margin-negative resections occurred in 85 (91%). Fourteen (15%) resections were attempted minimally invasively, including 2 converted without event. Grade 3 or 4 surgical adverse events were reported in 26 (28%), 30-day mortality in 4 (4%) and 90-day mortality in 5 (5%). Patients undergoing extended resection experienced similar rates of grade 3 or 4 adverse events (odds ratio, 0.95; 95% confidence interval, 0.42-3.8) but higher 30-day (1.3% vs 18.8%) (odds ratio, 17.54; 95% confidence interval, 1.75-181.8) and 90-day mortality (2.6% vs 18.8%) (odds ratio, 8.65; 95% confidence interval, 1.3-56.9). Conclusions: Lobectomy was performed safely following full-dose concurrent chemoradiotherapy in these multi-institutional prospective trials; however, increased mortality was noted with extended resections.