Induction Chemoradiotherapy Followed by Surgical Resection for Clinical T3 or T4 Locally Advanced Non–Small Cell Lung Cancer

Purpose

To examine the usefulness of trimodality therapy in patients with clinical T3 or T4 (cT3?C4) locally advanced non?Csmall cell lung cancer (LA-NSCLC).

Methods

Between 1997 and 2009, a total of 76 LA-NSCLC patients with cT3?C4 underwent surgery. Among them, 36 patients underwent induction chemoradiotherapy with docetaxel and cisplatin plus concurrent radiation followed by surgery (IC group). The other 40 patients initially underwent surgery (IS group). The outcomes of the IC and IS groups were then investigated. To minimize possible biases caused by confounding treatment indications, we performed a retrospective cohort analysis by applying a propensity score (PS). Patients were divided into three groups according to PS tertiles, and comparisons between the IC and IS groups were made by PS tertile-stratified Cox proportional hazard models.

Results

For the entire cohort, which had a median follow-up duration of 48?months, the 3- and 5-year overall survival rates were 83.8 and 78.9%, respectively, in the IC group, versus 66.8 and 56.5%, respectively, in the IS group (P?=?0.0092). After adjustments for potentially confounding variables, the IC group continued to have a significantly longer overall survival than the IS group (P?=?0.0045). In addition, when the analysis was limited to 52 patients with cT3?C4N0 or N1 disease, the IC group had a significantly longer overall survival than the IS group after adjustments for confounding variables (P?=?0.019).

Conclusions

Our study indicates that trimodality therapy is highly effective in patients with cT3?C4 LA-NSCLC.     

Minimal Extrathyroid Extension Does Not Affect the Relapse-Free Survival of Patients with Papillary Thyroid Carcinoma Measuring 4 cm or Less over the Age of 45 Years

Purpose In the most recent version of the UICC TNM classification system for thyroid carcinoma, tumors with minimal extrathyroid extension were classified as T3. In this study, we investigated whether this upgrading is appropriate for papillary thyroid carcinoma. Methods We investigated the difference in the relapse-free survival (RFS) rate between patients with tumors having no, minimal, and massive extrathyroid extension in a series of 502 patients over the age of 45 years. Results Patients with tumors showing massive extension showed a worse RFS rate except for those with tumors measuring 1 cm or less. However, there was no significant difference in RFS between tumors measuring 4 cm or less showing no or minimal extension. In an investigation of 409 patients without any clinically apparent node metastasis, the RFS of patients with tumors larger than 4 cm with massive extension was significantly worse than those with tumors measuring 4 cm or less, while the RFS of patients with tumors with either no or minimal extension did not depend on the tumor size. Conclusions These findings suggest that tumors with minimal extension should be classified to have the same T grade as those without such extension, and upstaging of such tumors is therefore not appropriate.