title: Multidisciplinary therapy of stage IIIA non-small-cell lung cancer: long-term outcome of chemoradiation with or without surgery.
abstract: BACKGROUND
  Stage IIIA non-small-cell lung cancer (NSCLC) is highly heterogeneous due to differences in the size of the primary tumor and the extent and location of nodal disease. Although the addition of surgery to chemoradiation did not improve overall survival (OS) for stage IIIA patients in a randomized intergroup trial (INT 0139), subset analyses of the trial suggest that a trimodality approach incorporating lobectomy may be superior to bimodality therapy with chemoradiation alone.
  
  
  METHODS
  We analyzed the outcomes of patients with stage IIIA NSCLC (T3N1, T1-3N2) treated at our center between January 2000 and December 2008. We compared OS for those undergoing definitive chemoradiation to those undergoing chemoradiation followed by either lobectomy or pneumonectomy. Demographic variables were balanced by propensity score analysis method.
  
  
  RESULTS
  In our analysis of 249 patients, the median age was 65 years, 43% were men, and 96.5% had N2 disease. Chemoradiation followed by lobectomy yielded superior OS compared with chemoradiation (median OS 39 months vs 22 months, P = .038 after propensity score adjustment). There was no significant survival benefit for pneumonectomy over chemoradiation (median survival 28 months vs 22 months, P = .534).
  
  
  CONCLUSIONS
  Our data corroborate the findings of the INT 0139 trial. We propose that a formal randomized trial be performed comparing chemoradiation followed by lobectomy vs definitive chemoradiation in patients with stage IIIA disease whose tumors are resectable by lobectomy. Our data do not support the incorporation of pneumonectomy in the management of stage IIIA patients with N2 disease.
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA. charu.aggarwal@uphs.upenn.edu.
authors.forename: Charu
authors.initials: C
authors.lastname: Aggarwal
authors.forename: Linna
authors.initials: L
authors.lastname: Li
authors.forename: Hossein
authors.initials: H
authors.lastname: Borghaei
authors.forename: Ranee
authors.initials: R
authors.lastname: Mehra
authors.forename: Neeta
authors.initials: N
authors.lastname: Somaiah
authors.forename: Aruna
authors.initials: A
authors.lastname: Turaka
authors.forename: Corey J
authors.initials: CJ
authors.lastname: Langer
authors.forename: George R
authors.initials: GR
authors.lastname: Simon
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome