title: Neoadjuvant chemoradiation for clinically advanced non-small cell lung cancer: an analysis of 233 patients.
abstract: BACKGROUND
  Surgical intervention after chemoradiation for locoregionally advanced non-small cell lung cancer (NSCLC) is controversial. This study evaluated patient survival after neoadjuvant chemoradiation and anatomic pulmonary resections for locoregionally advanced NSCLC.
  
  
  METHODS
  Clinicopathologic data were retrospectively collected for 233 patients (110 women, 123 men) with NSCLC who underwent chemoradiation therapy, followed by pneumonectomy, sleeve lobectomy, bilobectomy, and standard lobectomy, from 1989 to 2008. Univariate log-rank analysis of Kaplan-Meier survival curves and multivariate Cox regression analysis was performed.
  
  
  RESULTS
  Final pathologic stages were complete responders, 52 (22%); I, 56 (24%); II, 39 (17%); and III, 86 (37%). Final pathologic lymph node status was N0, 130 (56%); N1, 28 (12%); and N2, 75 (32%). Overall 5-year survival for the cohort was 43%. The 90-day mortality was 8% (18 of 233). The 5-year survival was 33% for pneumectomy vs 51% for lobectomy (p=0.002). Survival rates at 5 years by stage were complete responders, 58%; I, 50%; II, 41%; and III, 32%; by primary tumor status, T0, 50%; T2, 38%; T3, 29%; and T4, 28%; and by final pathologic nodal status, N0, 51%; N1, 40%; N2, 32% (N0 vs N1, p=0.236; N1 vs N2, p=0.704; N0 vs N2, p=0.019; N0 vs N1+N2, p=0.020). Multivariate analysis demonstrated pneumonectomy was associated with decreased 5-year survival (hazard risk, 1.5162; 95% confidence interval, 10.05028 to 2.189, p=0.0263).
  
  
  CONCLUSIONS
  Respectable survival can be achieved after neoadjuvant chemoradiation, followed by anatomic resection, in selected patients with clinically advanced NSCLC. A T0 primary tumor or N0 lymph node status individually, or together as a complete response (T0 N0) status, is associated with the best long-term survival. Survival is most favorable for lobectomies vs pneumonectomies after neoadjuvant chemoradiation therapy.
authors.affiliation: Section of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Liptay
authors.forename: Philip
authors.initials: P
authors.lastname: Bonomi
authors.forename: William H
authors.initials: WH
authors.lastname: Warren
authors.forename: Sanjib
authors.initials: S
authors.lastname: Basu
authors.forename: Erin C
authors.initials: EC
authors.lastname: Farlow
authors.forename: L Penfield
authors.initials: LP
authors.lastname: Faber
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome