title: Stage IIIA non-small cell lung cancer: morbidity and mortality of three distinct multimodality regimens.
abstract: BACKGROUND
  Although concurrent chemoradiation therapy can cure stage IIIA non-small cell lung cancer (NSCLC), studies have demonstrated that anatomic resection following high-dose or standard-dose chemoradiation may benefit selected patients. We examined morbidity and mortality associated with 3 multimodality treatment regimens for stage IIIA disease.
  
  
  METHODS
  Institutional databases identified patients with stage IIIA (N2) NSCLC who underwent concurrent platinum-based chemoradiotherapy with or without pulmonary resection between 1998 and 2011. Exclusion criteria included palliative regimens, sequential chemoradiotherapy, radiation-surgery interval greater than 12 weeks, superior sulcus tumors, or radiotherapy other than standard external beam radiation. Treatment-related morbidity and mortality were examined for the following treatment regimens: neoadjuvant chemoradiotherapy with 45 Gy followed by surgery (trimodality-45); neoadjuvant chemoradiotherapy with 60 Gy or more followed by surgery (trimodality-60); and definitive chemoradiotherapy with 60 Gy or more without surgery (D-CRT).
  
  
  RESULTS
  During the study period, 144 patients met eligibility criteria including 27 trimodality-45, 29 trimodality-60, and 88 D-CRT patients. Treatment-related morbidity and mortality rates for D-CRT were 74% [65 of 88] and 2.3% [2 of 88], respectively. Postoperative morbidity and mortality rates for patients who proceeded to surgery were 48% [27 of 56] and 1.8% [1 of 56], respectively, and did not differ based on dose of neoadjuvant radiation. Despite varied anatomic resections and methods of bronchial closure and coverage, no bronchopleural fistulae were observed.
  
  
  CONCLUSIONS
  Chemoradiotherapy carries a significant morbidity profile. However, high-dose neoadjuvant radiation is not associated with increased postoperative morbidity or mortality relative to standard-dose radiation in patients selected for anatomic resection.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seder
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Olivier
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging