Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society). (2024)

Affiliation

• Couñago F; Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain; Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain. Electronic address: felipe.counago@quironsalud.es.
• Rodriguez de Dios N; Department of Radiation Oncology, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. Electronic address: nrodriguez@parcdesalutmar.cat.
• Montemuiño S; Department of Radiation Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain. Electronic address: sara.montemuino@salud.madrid.org.
• Jové-Teixidó J; Department of Radiation Oncology, Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain. Electronic address: jjove@iconcologia.net.
• Martin M; Department of Radiation Oncology, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo Km9, Madrid, Spain. Electronic address: margarita.martin@salud.madrid.org.
• Calvo-Crespo P; Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Choupana s/n, bloque d. Santiago de Compostela, A Coruña, Spain. Electronic address: patricia.calvo.crespo@sergas.es.
• López-Mata M; Department of Radiation Oncology, Hospital Clinico Universitario Lozano Blesa, San Juan Bosco 15, Zaragoza, Spain. Electronic address: mlopezmat@salud.aragon.es.
• Samper-Ots MP; Department of Radiation Oncology, Hospital Universitario Rey Juan Carlos, C/Gladiolo s/n. Móstoles, Madrid, Spain. Electronic address: pilar.samper@hospitalreyjuancarlos.es.
• López-Guerra JL; Department of Radiation Oncology, Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, S/N, 41013 Sevilla, Spain. Electronic address: chanodetriana@yahoo.es.
• García-Cañibano T; Department of Radiation Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain. Electronic address: tgcanibano@salud.madrid.org.
• Díaz-Díaz V; Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cadiz, Spain. Electronic address: veronica.diaz.sspa@juntadeandalucia.es.
• de Ingunza-Barón L; Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cadiz, Spain. Electronic address: lourdes.ingunza@gmail.com.
• Murcia-Mejía M; Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Av. del Dr. Josep Laporte, 2, 43204 Reus, Tarragona, Spain. Electronic address: mauricio.murcia@grupsagessa.com.
• Alcántara P; Department of Radiation Oncology. Hospital Universitario Clínico San Carlos, C/Prof. Martín Lagos s/n, Madrid, Spain. Electronic address: malcanta@ucm.es.
• Corona J; Department of Radiation Oncology. Hospital Universitario Clínico San Carlos, C/Prof. Martín Lagos s/n, Madrid, Spain. Electronic address: juanantonio.corona@salud.madrid.org.
• Puertas MM; Department of Radiation Oncology, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain. Electronic address: mmpuertas@salud.aragon.es.
• Chust M; Department of Radiation Oncology, Instituto Valenciano de Oncologia, Carrer del Professor Beltrán Báguena, 8, 46009, Valencia, Spain. Electronic address: mchust@fivo.org.
• Couselo ML; Department of Radiation Oncology, Hospital Central de la Defensa Gomez Ulla, Glorieta Ejército, 1, 28047, Madrid, Spain. Electronic address: mcoupan@oc.mde.es.
• Del Cerro E; Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain; Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain. Electronic address: elia.delcerro@quironsalud.es.
• Moradiellos J; Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain. Electronic address: javier.moradiellos@quironsalud.es.
• Amor S; Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain. Electronic address: sergio.amor@quironsalud.es.
• Varela A; Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain. Electronic address: andres.varela@quironsalud.es.
• Thuissard IJ; School of Doctoral Studies & Research, Universidad Europea, Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain. Electronic address: israeljohn.thuissard@universidadeuropea.es.
• Sanz-Rosa D; School of Doctoral Studies & Research, Universidad Europea, Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain. Electronic address: david.sanz@universidadeuropea.es.
• Taboada B; Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Choupana s/n, bloque d. Santiago de Compostela, A Coruña, Spain. Electronic address: maria.begona.taboada.valladares@sergas.es.

ABSTRACT

OBJECTIVES:

The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT). MATERIAL AND

METHODS:

A total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group).

RESULTS:

Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p < 0.001) were significantly higher in the CRTS group. This survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup versus dCRT (OS 57 vs 29 months, p < 0.001; PFS 46 vs 15 months, p < 0.001), but not in the comparison between the pneumonectomy subgroup and dCRT.

CONCLUSION:

The findings reported here indicate that neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy) yields better OS and PFS than definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC.