National patterns of care and outcomes after combined modality therapy for stage IIIA non-small-cell lung cancer.
BACKGROUND
The role of surgery in addition to chemotherapy and radiation for stage IIIA non-small-cell lung cancer (NSCLC) remains controversial. Because there are limited data on the benefit from surgery in this setting, we evaluated the use of combined modality therapy nationally and explored the outcomes with and without the addition of surgery.


METHODS
Patient variables and treatment-related outcomes were abstracted for patients with clinical stage IIIA NSCLC from the National Cancer Database. Patients receiving chemotherapy and radiation were compared with those undergoing chemotherapy, radiation, and surgery (CRS) in any sequence.


RESULTS
Between 1998 and 2010, 61,339 patients underwent combined modality treatment for clinical stage IIIA NSCLC. Of these, 51,979 (84.7%) received chemotherapy and radiation while 9360 (15.3%) underwent CRS. Patients in the CRS group were younger, more likely female patients and Caucasians, and had smaller tumors and lower Charlson comorbidity scores. The 30-day surgical mortality was 200 of 8993 (2.2%). The median overall survival favored the CRS group in both unmatched (32.4 months versus 15.7 months, p < 0.001) and matched analysis based on patient characteristics (34.3 versus 18.4 months, p < 0.001).


CONCLUSIONS
There is significant heterogeneity in the treatment of stage IIIA NSCLC in the United States. Patients selected for surgery in addition to chemoradiation therapy seem to have better long-term survival.
*Department of Surgery, Division of Cardiothoracic Surgery; †Department of Radiation Oncology; and ‡Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO.
Aalok P
AP
Patel
Traves D
TD
Crabtree
Jennifer M
JM
Bell
Tracey J
TJ
Guthrie
Clifford G
CG
Robinson
Daniel
D
Morgensztern
Graham A
GA
Colditz
Daniel
D
Kreisel
A Sasha
AS
Krupnick
Jeffrey D
JD
Bradley
G Alexander
GA
Patterson
Bryan F
BF
Meyers
Varun
V
Puri
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000706:statistics & numerical data*; D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000401:mortality / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000970:Antineoplastic Agents