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Author Notes:

Jessica S. Donington, MD, MSCR, Professor and Chief, Thoracic Surgery, University of Chicago Medicine, 5758 S. Maryland Ave, Suite S500, Chicago, IL 60637, 773-702-3551. Email: jdonington@uchicago.edu

We would like to thank the following doctors for accruing patients to the studies associated with this paper, Steven J Feigenberg, MD, University of Maryland School of Medicine, Elizabeth M Gore, MD, Medical College of Wisconsin, Vita V McCabe, MD, Michigan Cancer Research Consortiums, Cliff G Robinson, MD, Washington University School of Medicine, Gregory M Videtic, MD, Case Western Reserve/University Hospital Seidman Cancer Center, Nathaniel R Evans, MD, Thomas Jefferson University, Sidney Kimmel Medical College, Paul J Thurmes, MD, Metro-Minnesota CCOP, Maximilian Diehn, MD PhD, Stanford Cancer Institute, Roy H Decker, MD, Yale School of Medicine.

Dr. Donington reports honorarium and travel expenses from AstraZeneca, outside the submitted work. Ms. Paulus reports grant from NCI and Amgen for the work under consideration. Dr. Edelman reports grants (to institution) and consulting fees from BMS, Lilly Oncology, Ariad and Genentech, outside the submitted work. Dr. Le reports grants from RedHil, Varian, and Amgen and travel fees from BMS, outside the submitted work. Dr. Loo Jr reports grants from Varian Medical Systems and RaySearch Laboratories, honoraria from Varian Medical Systems and that he is a board member of TibaRay, Inc., outside the submitted work. Dr. Robinson reports grants from Varian and Elekta, and personal fees from Varian and ViewRay, outside the submitted work. Dr. Diehn reports a grant from Varian Medical Systems, outside the submitted work. Dr. Decker reports a grant from Merck & Co and advisory board fees from Regeneron Pharmaceuticals, outside the submitted work. Dr. Hu reports a grant from NCI for the work under consideration, a grant from NCI and personal fees and non-financial support from Varian Medical Systems, outside the submitted work. Dr. Bradley reports a grant (to institution) and travel fees from Mevion Medical Systems, Inc and scientific advisory board fees from ViewRay and Varian Medical, outside the submitted work.

Subjects:

Research Funding:

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:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Respiratory System
  • Surgery
  • Cardiovascular System & Cardiology
  • lung cancer
  • induction therapy
  • surgery
  • radiation
  • chemotherapy
  • PHASE-II
  • SURGICAL RESECTION
  • NEOADJUVANT CHEMORADIATION
  • INDUCTION CHEMORADIATION
  • PULMONARY RESECTION
  • THORACIC RADIATION
  • RANDOMIZED TRIAL
  • RADIOTHERAPY
  • SURGERY
  • CARBOPLATIN

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

Tools:

Journal Title:

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY

Volume:

Volume 160, Number 5

Publisher:

, Pages 1331-+

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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