Trimodality therapy for stage IIIA non-small cell lung cancer: benchmarking multi-disciplinary team decision-making and function
Menée sur 90 patients atteints d'un cancer du poumon non à petites cellules de stade IIIA traité entre 2007 et 2011, cette étude identifie les caractéristiques cliniques des patients recevant un traitement trimodal et évalue, du point de vue de la survie à long terme, l'efficacité de ce traitement par rapport à une chimioradiothérapie concomitante
Objectives : Although the standard treatment for patients with stage IIIA non-small cell lung cancer (NSCLC) is chemoradiotherapy, some patients are considered for trimodality therapy [TT]. We analysed outcomes for stage IIIA NSCLC, treated with TT and compared them with concurrent chemoradiotherapy [con-CRT]. Materials and Methods : Patients treated between Jan 2007-Dec 2011 were retrospectively analysed. Not included were patients with sulcus superior tumors, unknown T/N-status, or recurrent disease after con-CRT followed by surgery. All patients were discussed at our multidisciplinary thoracic tumor board (MTB). Results : Mean Charlson Comorbidity Index was 2 for TT and con-CRT patients. TT patients were younger (median TT = 56yrs vs. con-CRT = 62yrs; p = 0.001) and had less advanced cN-stage (TT cN2 = 41% vs. 83% for CRT; p < 0.001). 44% of TT patients had T4-stage vs. 12% of con-CRT patients. Median RT dose was lower for TT (50 Gy vs. 66 Gy; p = 0.001) and median RT planning target volume (PTV) in TT and con-CRT patients was 525cm3 and 655cm3 (p = 0.010), respectively. The majority of TT patients had a lobectomy (23/32). Median follow-up was 30.3 months (95%CI = 18.7-41.9) for TT and 51 months (95%CI = 24.9-77.4) for con-CRT. Median overall survival was not reached for TT and was 18.6 months (95% CI = 12.8-24.4) for con-CRT (p = 0.001). For PTV</≥500cm3, median OS for TT was not reached/33.9 months and 29.1/17.1 months for con-CRT. TT patients with cN0/1 had better survival than those receiving con-CRT (p = 0.015), but those with cN2 did not (p = 0.158). The 90-day mortality from start of RT was 0% (0/32) for TT and 1.7% (1/58) for con-CRT. 90-day post-operative mortality for TT was 3.1% (1/32, event unrelated to TT). Conclusions : Selected patients with IIIA NSCLC treated with TT had favorable long-term survival with acceptable short-term mortality. These outcomes support the decision-making and function of our MTB/treatment team. The role of TT in cN2 disease and large tumors merits further evaluation.