PMID- 30227129
OWN - NLM
STAT- MEDLINE
DCOM- 20191015
LR  - 20200202
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 107
IP  - 1
DP  - 2019 Jan
TI  - Multimodality Therapy for N2 Non-Small Cell Lung Cancer: An Evolving Paradigm.
PG  - 277-284
LID - S0003-4975(18)31254-2 [pii]
LID - 10.1016/j.athoracsur.2018.07.033 [doi]
AB  - BACKGROUND: Induction chemoradiation for resectable N2 non-small cell lung cancer 
      (NSCLC) is used with the intent to optimize locoregional control, whereas 
      induction chemotherapy given in systemic doses is meant to optimally target 
      potential distant disease. However, the optimal preoperative treatment regimen is 
      still unknown and practice patterns continue to vary widely. We compared 
      multiinstitutional oncologic outcomes for N2 NSCLC from 4 experienced lung cancer 
      treatment centers. METHODS: This collaborative retrospective study unites 4 major 
      thoracic oncology centers. Patients with N2 NSCLC undergoing surgical resection 
      after induction chemotherapy (CxT) or concurrent chemoradiation (CxRT) were 
      included. Primary outcomes were overall and disease-free survival (OS and DFS). 
      RESULTS: 822 patients were identified (CxT = 662 and CxRT = 160). There were no 
      differences in 5-year OS (CxT 39.9% versus CxRT 42.9%, p = 0.250) nor in DFS (CxT 
      28.7% versus 29.8%, p = 0.207). Recurrence rates (CxT 46.8% versus CxRT 51.6%, 
      p = 0.282) and recurrence patterns were not significantly different (Local: CxT 
      9.8% versus CxRT 9.7%; and Distant: CxT 30.4% versus CxRT 33.1%, p = 0.764). 
      There was no difference in perioperative mortality. In the analyses of patients 
      who underwent pretreatment invasive mediastinal staging (n = 555), there were 
      still no significant differences in OS (p = 0.341) and DFS (p = 0.455) between 
      the 2 treatment strategies. CONCLUSIONS: Both treatment strategies produce 
      equivalent and better than expected outcomes compared with historical controls 
      for N2 NSCLC, with no differences in recurrence patterns. How these conventional 
      therapeutic strategies will compare with those involving immunotherapy combined 
      with surgical locoregional disease control for N2 disease remains to be 
      determined.
CI  - Copyright (c) 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Spicer, Jonathan D
AU  - Spicer JD
AD  - Division of Thoracic Surgery, McGill University Health Centre, Montreal, Quebec, 
      Canada. Electronic address: jonathan.spicer@mcgill.ca.
FAU - Shewale, Jitesh B
AU  - Shewale JB
AD  - Department of Thoracic and Cardiovascular Surgery, The University of Texas MD 
      Anderson Cancer Center, Houston, Texas; Department of Epidemiology, Human 
      Genetics and Environmental Sciences, The University of Texas Health Science 
      Center (UTHealth) School of Public Health, Houston, Texas.
FAU - Nelson, David B
AU  - Nelson DB
AD  - Department of Thoracic and Cardiovascular Surgery, The University of Texas MD 
      Anderson Cancer Center, Houston, Texas.
FAU - Mitchell, Kyle G
AU  - Mitchell KG
AD  - Department of Thoracic and Cardiovascular Surgery, The University of Texas MD 
      Anderson Cancer Center, Houston, Texas.
FAU - Bott, Matthew J
AU  - Bott MJ
AD  - Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 
      New York, New York.
FAU - Vallieres, Eric
AU  - Vallieres E
AD  - Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
FAU - Wilshire, Candice L
AU  - Wilshire CL
AD  - Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
FAU - Vaporciyan, Ara A
AU  - Vaporciyan AA
AD  - Department of Thoracic and Cardiovascular Surgery, The University of Texas MD 
      Anderson Cancer Center, Houston, Texas.
FAU - Swisher, Stephen G
AU  - Swisher SG
AD  - Department of Thoracic and Cardiovascular Surgery, The University of Texas MD 
      Anderson Cancer Center, Houston, Texas.
FAU - Jones, David R
AU  - Jones DR
AD  - Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 
      New York, New York.
FAU - Darling, Gail E
AU  - Darling GE
AD  - Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
FAU - Sepesi, Boris
AU  - Sepesi B
AD  - Department of Thoracic and Cardiovascular Surgery, The University of Texas MD 
      Anderson Cancer Center, Houston, Texas.
LA  - eng
GR  - P30 CA008748/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
DEP - 20180915
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
RN  - 0 (Antineoplastic Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antineoplastic Agents/*therapeutic use
MH  - Carcinoma, Non-Small-Cell Lung/diagnosis/mortality/*therapy
MH  - Combined Modality Therapy
MH  - Disease-Free Survival
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Induction Chemotherapy
MH  - Lung Neoplasms/diagnosis/mortality/*therapy
MH  - Male
MH  - Middle Aged
MH  - *Neoplasm Staging
MH  - North America/epidemiology
MH  - Pneumonectomy/*methods
MH  - Radiotherapy, Adjuvant
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Treatment Outcome
PMC - PMC6993842
MID - NIHMS1062701
EDAT- 2018/09/19 06:00
MHDA- 2019/10/16 06:00
PMCR- 2020/01/31
CRDT- 2018/09/19 06:00
PHST- 2018/02/20 00:00 [received]
PHST- 2018/06/09 00:00 [revised]
PHST- 2018/07/09 00:00 [accepted]
PHST- 2018/09/19 06:00 [pubmed]
PHST- 2019/10/16 06:00 [medline]
PHST- 2018/09/19 06:00 [entrez]
PHST- 2020/01/31 00:00 [pmc-release]
AID - S0003-4975(18)31254-2 [pii]
AID - 10.1016/j.athoracsur.2018.07.033 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2019 Jan;107(1):277-284. doi: 10.1016/j.athoracsur.2018.07.033. 
      Epub 2018 Sep 15.