April 28, 2015
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Induction chemoradiation not associated with improved OS in NSCLC

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SEATTLE — Induction chemoradiation did not improve overall survival in patients with stage IIIA-N2 non-small cell lung cancer when compared with induction chemotherapy alone, according to results presented at the American Association for Thoracic Surgery Annual Meeting.

“There are no significant differences in perioperative mortality between the two groups,” Chi-Fu Jeffrey Yang, MD, of Duke University, said during a presentation. “Induction chemoradiation was associated with a higher rate of primary tumor and mediastinal nodal down-staging; however, the addition of radiation to induction chemotherapy was not associated with a significant improvement in overall survival rate.”

Yang and colleagues assessed induction radiation use and survival of 1,362 patients with stage IIIA-N2 non-small cell lung cancer (NSCLC) from the National Cancer Database. All had received induction chemotherapy followed by lobectomy or pneumonectomy from 2003 to 2006.

Eighty-four percent of the patients who received induction chemotherapy (n = 528) underwent lobectomy compared with 80% of patients who received induction chemoradiation (n = 834). Approximately 1% of chemotherapy patients undergoing lobectomy had perioperative mortality vs. 3% of patients receiving chemoradiation. Eight percent of chemotherapy patients had perioperative mortality after pneumonectomy compared with 6% of those who received chemoradiation.

Patients receiving induction chemoradiation had a median survival of 3.3 years and a 41.4% OS rate at 5 years, while induction chemotherapy patients had a median survival of 3.4 years and a 5-year OS rate of 40.8%.

Overall survival after induction therapy and then lobectomy was comparable between groups. Patients receiving chemoradiation therapy had a median survival of 3.9 years, while chemotherapy patients had a median survival of 3.6 years (adjusted HR = 1.01; 95% CI, 0.86-1.18). Five-year survival for chemoradiation patients was 44%, compared with 42.3% for induction chemotherapy.

Similar OS results were reported for induction therapy followed by pneumonectomy. Chemoradiation was associated with a median survival of 2.1 years; chemotherapy patients had a median survival of 2.4 years (aHR = 1.15; 95% CI, 0.8-1.65). Five-year survival rates were 32% and 33% for induction chemoradiation and chemotherapy, respectively.

“The use of concurrent chemoradiation vs. chemotherapy followed by surgery for optimal stage IIIA-N2 disease should be re-examined in the context of randomized trials,” he said. “Future prospective, retrospective studies should be focused on identifying characteristics that could be used to indicate if and when radiation is needed in addition to chemotherapy.” – by Ryan McDonald

Reference:

Yang C-FJ, et al. Abstract 24. Presented at: the American Association for Thoracic Surgery Annual Meeting; April 25-29, 2015; Seattle.

Disclosure: Yang reports no relevant financial disclosures.