title: Adding radiation to induction chemotherapy does not improve survival of patients with operable clinical N2 non-small cell lung cancer.
abstract: OBJECTIVE
  Radiotherapy is commonly used in induction regimens for patients with non-small cell lung cancer with operable mediastinal nodal disease, although evidence has not shown a benefit over induction chemotherapy alone. We compared outcomes between induction chemotherapy and induction chemoradiation using the National Cancer Data Base.
  
  
  METHODS
  Induction radiation use and survival of patients who underwent lobectomy or pneumonectomy after induction chemotherapy for clinical T1-3N2M0 non-small cell lung cancer in the National Cancer Data Base from 2003 to 2006 were assessed using logistic regression, general linear regression, Kaplan-Meier, and Cox proportional hazard analysis.
  
  
  RESULTS
  Of 1362 patients who met study criteria, 834 (61%) underwent induction chemoradiation and 528 (39%) underwent induction chemotherapy. Lobectomy was performed in 82% of patients (n = 1111), and pneumonectomy was performed in 18% of patients (n = 251). Pneumonectomy was performed more often after induction chemoradiation than after induction chemotherapy (20% vs 16%, P = .04). Downstaging from N2 to N0/N1 was more common with induction chemoradiation compared with induction chemotherapy (58% vs 46%, P < .01), but 5-year survival of patients receiving induction chemoradiation and patients receiving induction chemotherapy was similar in unadjusted analysis (41% vs 41%, P = .41). In multivariable analysis, the addition of radiation to induction chemotherapy also was not associated with a survival benefit (hazard ratio, 1.03; 95% confidence interval, 0.89-1.18; P = .73).
  
  
  CONCLUSIONS
  Induction chemoradiation is used in the majority of patients with non-small cell lung cancer with N2 disease who undergo induction therapy before surgical resection, but it is not associated with improved survival compared with induction chemotherapy.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Chi-Fu Jeffrey
authors.initials: CF
authors.lastname: Yang
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Department of Biostatistics, Duke University, Durham, NC.
authors.forename: Lin
authors.initials: L
authors.lastname: Gu
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Biostatistics, Duke University, Durham, NC.
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC. Electronic address: matthew.hartwig@duke.edu.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy; D015996:Survival Rate; D016896:Treatment Outcome
keywords: lung cancer surgery; neoadjuvant therapy