Multimodal Treatment in Operable Stage III Non-Small Cell Lung Cancer: A Pooled Analysis on Long Term Results of three SAKK trials (SAKK 16/96, 16/00, 16/01)
Menée à partir des données de trois essais cliniques de phase II ou III portant sur 368 patients atteints d'un cancer du poumon opérable non à petites cellules de stade III, cette étude évalue, du point de vue des taux de survie à 5 et 10 ans, l'intérêt d'ajouter une radiothérapie à une chimiothérapie néo-adjuvante
Background : Long term data on outcomes of operable stage III non-small cell lung cancer (NSCLC) are scarce. Patients and methods : Individual patient data of 368 patients enrolled in one phase III and two phase II trials were pooled and outcomes after applying the 8th (marked with *) vs. the 6th TNM staging edition were compared. Patients were treated with either preoperative radiotherapy following three cycles of induction chemotherapy (tri-modal) or neoadjuvant chemotherapy alone (bi-modal). Results : With the 6th version the 5- and 10-year survival rates were 38% and 28% for stage IIIA and 36% and 24% for stage IIIB. Factors associated with improved 5-year overall survival (OS) were younger age, R0 resection and pathologic complete remission (pCR) (P=0.043, P<0.001 and P=0.009). With the 8th TNM staging version 162 patients were moved from stage IIIA to IIIB*. The 5- and 10-year survival rates were 41% and 29% for stage IIIA* and 35% and 27% for stage IIIB* patients. There was no difference in the bi- vs. tri-modal group with regards to median OS (28 months [95% CI: 21–39 months] and 37 months [95% CI: 24-51 months], p=0.9) and event free survival (12 months [95% CI: 9–15 months] vs. 13 months [95% CI: 10-22 months], P=0.71). Conclusions : We showed favourable 10-year survival rates of 29% and 27% in stage IIIA* and IIIB*. Younger age, R0 resection and pCR was associated with improved long term survival. Outcomes using the 6th versus 8th edition of the TNM classification were similar in operable stage III NSCLC.