title: Impact of preoperative radiation on survival of patients with T3N0 >7-cm non-small cell lung cancers treated with anatomic resection using the Surveillance, Epidemiology, and End Results database.
abstract: BACKGROUND
  Very large non-small cell lung cancers (NSCLC) remain a therapeutic challenge. The objective of this study was to evaluate the effect of surgery in the presence and absence of neoadjuvant radiation (NRT) on survival of patients with T3N0 >7-cm NSCLCs.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database was used to identify patients undergoing lobectomy or pneumonectomy for T3N0 NSCLC tumors >7 cm from 1999-2008. Patients were categorized into groups based on type of surgery performed and whether NRT was used. Five-year overall (OS) and lung cancer-specific survival (LCSS) were estimated by the Kaplan-Meier method and comparisons made using log-rank tests and Cox regression models.
  
  
  RESULTS
  There were 1301 patients evaluated, including 1232 undergoing primary surgical therapy (PST) and 69 receiving NRT. NRT was not associated with improvements in 5-y OS (48% versus 41%, P = 0.062) or LCSS (59% versus 52%, P = 0.116) compared with PST. Lobectomies were associated with better 5-y OS (43% versus 33%; P = 0.006) and LCSS (54% versus 43%, P = 0.005) compared with pneumonectomies. On multivariate analysis, NRT did not produce any significant advantage in OS (P = 0.242) and LCSS (P = 0.208). Pneumonectomies were associated with significantly worse OS (hazard ratio, 1.32; P = 0.007) and LCSS (hazard ratio, 1.38; P = 0.005) when compared with lobectomies.
  
  
  CONCLUSIONS
  NRT, which most likely was a combination of chemotherapy and radiation, was not associated with improvements in OS or LCSS in patients with T3N0 >7-cm NSCLC compared with PST. When feasible, lobectomy appears more beneficial than pneumonectomy in terms of long-term survival for very large tumors.
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut 06520, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Moreno
authors.forename: Daniel
authors.initials: D
authors.lastname: Morgensztern
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.forename: Roy H
authors.initials: RH
authors.lastname: Decker
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods; D011013:Pneumonectomy / Q000401:mortality*; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D018426:SEER Program / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Anatomic resection; Neoadjuvant radiation therapy; Non–small cell lung cancer; SEER; T3; T3N0 tumors