Non-small cell lung cancer. The role of chemoimmunoradiotherapy after surgery

The aim of this study was to determine expediency of adjuvant chemoimmunoradiotherapy for radically operated non-small cell lung cancer patients (LCP) with pathologic stage II-III (T1-4N0-2M0G1-3). In retrospective trial (1985-1998) a 5-year survival of 54 consecutive radically operated LCP after adjuvant chemoimmunoradiotherapy (group A) was compared with 5-year survival of 264 LCP, after radical procedures (group C) and with 5-year survival of 86 radically operated LCP after postoperative radiotherapy (group B) (45-50 Gy). I cycle of chemoimmunotherapy was given on day 10-14 after complete resections. Radiotherapy (45-50 Gy) was administered since day 7 after 1 cycle. After irradiation 3-4 courses of CAVT were repeated every 21-28 day. Variables selected for 5-year survival and life span study were sex, age, TNMG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of LCP were evaluated using a log-rank test. Multivariate proportional hazard Cox regression, multi-factor clustering, structural equation modeling and Monte Carlo simulation were used to determine any significant overall regularity. 5-year survival was superior in group A (64.8%: 35 out of 54 LCP with N0-2; life span=1998.2+/-156.9 days) compared with group B (45.3%: 39 out of 86 LCP with N0-2; life span=1296.4+/-109.5 days) (P<0.001). 5-year survival of group C was 63.6% (168 out of 264 LCP with N0-2; life span=1738.3+/-63.4 days) (P>0.05 for group A and P<0.001 for group B). For LCP with N1-2 5-year survival was significantly superior for group A (63.6%: 21 from 33; life span=1934.0+/-180.9 days) compared with group C (28.1%: 25 out of 89; life span=1056.9+/-91.1 days) (P<0.001) and with group B (35.6%: 21 out of 59; life span=1051.7+/-119.6 days) (P<0.001). Structural equation modeling and Monte Carlo simulation confirmed significant overall differences between 5-year survival (P<0.05) and life span (P<0.001) of LCP with N1-2 in group A with respect to group C or B; however, 5-year survival of LCP for N0 in groups A, B and C were not significantly different.