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Published on: February 12, 2017
Trimodal therapy for histologically proven N2/3 non-small cell lung cancer: mid-term results and indicators for
Volker Steger1, Thorsten Walles, Bora Kosan
1Department of Thoracic Surgery, Schillerhöhe Hospital, Gerlingen, Germany. vrsteger@gmx.de
Background:
Surgery alone for stage III non-small cell lung cancer provides a 5-year survival of 20% and competes with multimodal treatments. In 1999, a trimodal protocol was implemented at the Schillerhöhe Clinic. The aim of this study was to verify the feasibility and outcome of this trimodal protocol including survival, risk factors for survival, and comorbidity in a single institution.
Methods:
Included were all patients with potentially resectable, previously untreated stage III non-small cell lung cancer operated on between February 1999 and May 2006 in the General Thoracic Surgery Unit of the Schillerhöhe Clinic following the same neoadjuvant protocol. Treatment-related morbidity, recurrence, survival after R0 resection, and risk factors for survival (pN0 after trimodal therapy, downstaging of International Union Against Cancer stage, T downstaging, N downstaging, regression rate, and histologic type of tumor) were analyzed.
Results:
From 107 patients with stage III non-small cell lung cancer, 55 patients with mediastinoscopy-positive N2 or N3 were eligible for this study. Forty patients (72%) had the effect of International Union Against Cancer downstaging. Treatment-related comorbidity was 54% with hospital and 120-day mortality of 3.6% and 5.4%, respectively. Overall mean survival (Kaplan-Meier) was 43 months (95% confidence interval, 35 to 52) with an estimated 5-year survival rate of 49%. In multivariate testing, International Union Against Cancer downstaging after trimodal therapy achieved a level of significance (p = 0.031), and patients with UICC-downstaging after trimodal therapy had a mean survival of 53 months (95% confidence interval, 44 to 63) with an estimated 5-year survival rate of 60%.
Conclusions:
Neoadjuvant trimodal treatment for histologically proven N2 or N3 stage III non-small cell lung cancer is promising and can, like no other approach at present time, considerably improve 5-year survival rates up to 63% in selected patients.
Insights
Neoadjuvant trimodal therapy significantly improves survival for stage III non-small cell lung cancer (NSCLC). This multimodal approach enhances 5-year survival rates in selected patients with N2 or N3 disease.
Area of Science:
- Thoracic Surgery
- Oncology
- Medical Research
Background:
- Stage III non-small cell lung cancer (NSCLC) has a poor prognosis with surgery alone (20% 5-year survival).
- Multimodal treatments are crucial for improving outcomes in advanced NSCLC.
- A trimodal protocol was implemented in 1999 to enhance treatment efficacy.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a neoadjuvant trimodal protocol for stage III NSCLC.
- To assess survival rates, risk factors, and comorbidity associated with the trimodal approach.
- To determine the impact of downstaging on patient survival.
Main Methods:
- Analysis of patients with potentially resectable, previously untreated stage III NSCLC (N2/N3) undergoing neoadjuvant therapy.
- Evaluation of treatment-related morbidity, recurrence, and survival post-R0 resection.
- Assessment of risk factors including International Union Against Cancer (UICC) staging, T/N downstaging, regression rate, and histology.
Main Results:
- 55 patients with mediastinoscopy-positive N2/N3 stage III NSCLC were included.
- 72% of patients achieved UICC downstaging.
- Overall 5-year survival was 49%, significantly improved to 60% in patients with UICC downstaging (p=0.031).
Conclusions:
- Neoadjuvant trimodal therapy is a promising approach for N2/N3 stage III NSCLC.
- This protocol can significantly improve 5-year survival rates, potentially up to 63% in selected patients.
- UICC downstaging after trimodal therapy is a significant positive prognostic factor.