Neoadjuvant Chemotherapy vs Chemoradiation Therapy Followed by Sleeve Resection for Resectable Lung Cancer

Area of Science:

• Thoracic Surgery
• Medical Oncology
• Radiation Oncology

Background:

• Neoadjuvant therapy followed by resection is standard for locally advanced non-small cell lung cancer (NSCLC).
• The specific risks and benefits of neoadjuvant approaches before sleeve lung resection are not well-defined.
• This study compares outcomes of neoadjuvant chemotherapy alone versus chemoradiation therapy prior to sleeve resection in NSCLC.

Purpose of the Study:

• To compare short- and long-term outcomes of neoadjuvant chemotherapy alone versus chemoradiation therapy in NSCLC patients undergoing sleeve lung resection.
• To evaluate the impact of neoadjuvant treatment modality on 30-day mortality, 90-day mortality, and overall survival.
• To provide evidence-based guidance for treatment selection in this specific patient population.

Main Methods:

• Utilized the National Cancer Database (2006-2017) to identify patients with locally advanced NSCLC who underwent sleeve resection after neoadjuvant chemotherapy or chemoradiation.
• Employed propensity score adjustment, logistic regression, Kaplan-Meier analysis, and Cox proportional hazards models to mitigate confounding and assess outcomes.
• Key outcomes analyzed included 30-day mortality, 90-day mortality, and overall survival.

Main Results:

• Of 176 patients, 92 (52.3%) received neoadjuvant chemotherapy alone and 84 (47.7%) received chemoradiation therapy.
• Patient demographics, comorbidities, insurance, socioeconomic status, histology, tumor location, and stage were well-balanced between groups.
• Neoadjuvant chemoradiation therapy was associated with significantly higher 90-day mortality (11.96% vs 2.38%, P = .015) but showed no difference in overall survival compared to chemotherapy alone.

Conclusions:

• In locally advanced NSCLC patients requiring sleeve resection, neoadjuvant chemoradiation therapy is linked to a fivefold increase in 90-day mortality.
• Neoadjuvant chemotherapy alone offers similar overall survival benefits without the heightened short-term mortality risk associated with chemoradiation.
• These findings suggest neoadjuvant chemotherapy alone may be a safer alternative to chemoradiation prior to sleeve lung resection in NSCLC.