RT Journal Article
T1 Pathological response to neoadjuvant therapy with chemotherapy vs chemoradiotherapy in stage III NSCLC-contribution of IASLC recommendations
A1 Munoz-Guglielmetti, Diego
A1 Sanchez-Lorente, David
A1 Reyes, Roxana
A1 Martinez, Daniel
A1 Lucena, Carmen
A1 Boada, Marc
A1 Paredes, Pilar
A1 Parera-Roig, Marta
A1 Vollmer, Ivan
A1 Mases, Joel
A1 Martin-Deleon, Roberto
A1 Castillo, Sergi
A1 Benegas, Mariana
A1 Munoz, Silvia
A1 Mayoral, Maria
A1 Cases, Carla
A1 Molla, Meritxell
A1 Casas, Francesc
K1 Non-small cell lung cancer
K1 Chemotherapy
K1 Chemoradiotherapy
K1 Neoadjuvant treatment
K1 Resectable stage III
K1 Pathological response
K1 Cell lung-cancer
K1 Preoperative chemotherapy
K1 Induction chemotherapy
K1 Phase-ii
K1 Concurrent chemoradiotherapy
K1 Surgical resection
K1 Surgery
K1 Chemoradiation
K1 Survival
K1 Radiotherapy
AB BACKGROUNDNeoadjuvant treatment (NT) with chemotherapy (Ch) is a standard option for resectable stage III (N2) NSCLC. Several studies have suggested benefits with the addition of radiotherapy (RT) to NT Ch. The International Association for the Study of Lung Cancer (IASLC) published recommendations for the pathological response (PHR) of NSCLC resection specimens after NT.AIMTo contribute to the IASLC recommendations showing our results of PHR to NT Ch vs NT chemoradiotherapy (ChRT).METHODSWe analyzed 67 consecutive patients with resectable stage III NSCLC with positive mediastinal nodes treated with surgery after NT Ch or NT ChRT between 2013 and 2020. After NT, all patients were evaluated for radiological response (RR) according to Response Evaluation Criteria in Solid Tumours criteria and evaluated for surgery by a specialized group of thoracic surgeons. All histological samples were examined by the same two pathologists. PHR was evaluated by the percentage of viable cells in the tumor and the resected lymph nodes.RESULTSForty patients underwent NT ChRT and 27 NT Ch. Fifty-six (83.6%) patients underwent surgery (35 ChRT and 21 Ch). The median time from ChRT to surgery was 6 wk (3-19) and 8 wk (3-21) for Ch patients. We observed significant differences in RR, with disease progression in 2.5% and 14.8% of patients with ChRT and Ch, respectively, and partial response in 62.5% ChRT vs 29.6% Ch (P = 0.025). In PHR we observed & LE; 10% viable cells in the tumor in 19 (54.4%) and 2 cases (9.5%), and in the resected lymph nodes (RLN) 30 (85.7%) and 7 (33.3%) in ChRT and Ch, respectively (P = 0.001). Downstaging was greater in the ChRT compared to the Ch group (80% vs 33.3%; P = 0.002). In the univariate analysis, NT ChRT had a significant impact on partial RR [odds ratio (OR) 12.5; 95% confidence interval (CI): 1.21 - 128.61; P = 0.034], a decreased risk of persistence of cancer cells in the tumor and RLN and an 87.5% increased probability for achieving downstaging (OR 8; 95%CI: 2.34-27.32; P = 0.001).CONCLUSIONWe found significant benefits in RR and PHR by adding RT to Ch as NT. A longer follow-up is necessary to assess the impact on clinical outcomes.
PB Baishideng publishing group inc
SN 2218-4333
YR 2021
FD 2021-11-24
LK https://hdl.handle.net/10668/25777
UL https://hdl.handle.net/10668/25777
LA en
DS RISalud
RD Apr 8, 2025