Chemoradiotherapy Before Surgery May Prolong Survival in Locally Advanced Lung Cancer

Patients with node-negative, locally advanced lung tumors who undergo induction chemoradiotherapy appear to survive significantly longer than patients who undergo surgical resection without induction chemoradiotherapy, according to preliminary results reported by a group from Boston University Medical Center. Results in 110 patients who were followed for an extended length of time show a greater than two-fold survival edge for surgically treated patients.

Benedict D. Daly, MD, and colleagues compared treatment outcomes in 47 patients who underwent neoadjuvant chemotherapy and 63 patients who underwent surgery and did not receive induction chemoradiotherapy, but instead underwent neoadjuvant radiation, adjuvant radiation, adjuvant chemotherapy, adjuvant chemoradiotherapy, brachytherapy, or no additional treatment. All patients had invasive T3 and T4 non—small cell lung cancer (NSCLC) and underwent treatment between 1979 and 2008. The analysis found that the median survival was longest for patients who had surgical resection and neoadjuvant chemoradiotherapy (90 mo) compared with resection and adjuvant external radiation therapy (25 mo), resection and neoadjuvant external radiation therapy (19 mo), or surgery alone (19 mo).

"The resolution of CT scanners has changed, PET imaging is now available, and invasive staging of the mediastinal lymph nodes has become routine."

-Benedict D. Daly, MD

Daly and associates pointed out that the results must be interpreted carefully given the improvements in the diagnosis, staging, and management of NSCLC that occurred during the study period. “The resolution of CT scanners has changed, PET imaging is now available, and invasive staging of the mediastinal lymph nodes has become routine,” they said. “As such, it is likely that a few of these patients were understaged or overstaged, affecting patient selection.”

Also, because patients were not randomized and staging was not uniform, the conclusions must be replicated in a prospective study that uses standardized staging and resection criteria.

Daly BD, Ebright MI, Walkey AJ, et al. Impact of neoadjuvant chemoradiotherapy followed by surgical resection on node-negative T3 and T4 non-small cell lung cancer [published online ahead of print January 29, 2011]. J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs. 2010.12.011.