title: Pathologic response rates following definitive dose image-guided chemoradiotherapy and resection for locally advanced non-small cell lung cancer.
abstract: BACKGROUND
  Treatment of technically operable, medically fit locoregionally advanced non-small cell lung cancer (NSCLC) patients is a controversial therapeutic challenge. Our group routinely uses a trimodality approach. Recent advances in radiotherapy allow for improved tumor targeting and daily patient positioning. We hypothesized that these technologies would improve pathologic response rates. We analyzed consecutively treated stage IIIA/IIIB NSCLC patients undergoing chemoradiotherapy before major lung resection, with particular attention paid to the impact of advanced technologies.
  
  
  METHODS
  Locoregionally advanced NSCLC patients (N2) staged in a multidisciplinary forum with mediastinoscopy were planned to receive platinum-based chemotherapy and 60Gy and major lung resection. Four-dimensional CT (4DCT) and image-guided radiotherapy (IGRT) were used as available. Survival endpoints were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analysis was performed using Cox proportional hazards models.
  
  
  RESULTS
  We identified 53 patients from 2/1999 to 2/2010. Median RT dose was 59Gy. 68% underwent lobectomy. Forty-three patients were downstaged pathologically (81%), 38 experienced mediastinal sterilization (72%), and 21 (40%) had complete pathologic response (pCR). 1 and 2 year OS were 85.5% and 61.6%. Superior OS and DFS were associated with nodal downstaging and mediastinal sterilization (pN0). Treatment with IGRT/4DCT in 10 patients resulted in high rates of nodal downstaging (100% vs 77%, p=0.0452), mediastinal sterilization (90% vs 67%, p=0.0769), and pCR (60% vs 35%, p=0.0728).
  
  
  CONCLUSIONS
  In selected patients, definitive dose CRT followed by major lung resection results in promising DFS and OS. The use of advanced radiotherapy techniques (4DCT and IGRT) appears to result in promising pathologic response rates.
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: D
authors.initials: D
authors.lastname: Shumway
authors.forename: K
authors.initials: K
authors.lastname: Corbin
authors.forename: R
authors.initials: R
authors.lastname: Salgia
authors.forename: P
authors.initials: P
authors.lastname: Hoffman
authors.forename: V
authors.initials: V
authors.lastname: Villaflor
authors.forename: R M
authors.initials: RM
authors.lastname: Malik
authors.forename: D J
authors.initials: DJ
authors.lastname: Haraf
authors.forename: W T
authors.initials: WT
authors.lastname: Vigneswaren
authors.forename: A Y
authors.initials: AY
authors.lastname: Shaikh
authors.forename: P P
authors.initials: PP
authors.lastname: Connell
authors.forename: M K
authors.initials: MK
authors.lastname: Ferguson
authors.forename: J K
authors.initials: JK
authors.lastname: Salama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D059248:Chemoradiotherapy; D018450:Disease Progression; D005260:Female; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D061089:Radiotherapy, Image-Guided; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome