Multimodal Treatment in Operable Stage III NSCLC: A Pooled Analysis on Long-Term Results of Three SAKK trials (SAKK 16/96, 16/00, and 16/01) |
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| Authors: | Martin Früh Daniel C Betticher Roger Stupp Alexandros Xyrafas Solange Peters Hans Beat Ris Rene Olivier Mirimanoff Adrian F Ochsenbein Ralph Schmid Oscar Matzinger Rolf A Stahel Walter Weder Matthias Guckenberger Sacha I Rothschild Didier Lardinois Nicholas Mach Michael Mark Oliver Gautschi Miklos Pless |
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| Institution: | 1. Department of Medical Oncology/Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland; University of Bern, Bern, Switzerland;2. Clinics of Medical Oncology, Cantonal Hospital of Fribourg (HFR), Fribourg, Switzerland;3. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois;4. Department of Medical Oncology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland;5. SAKK Coordinating Center, Bern, Switzerland;6. Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland;7. Department of Radio-Oncology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland;8. Department of Medical Oncology, University Hospital of Bern (Inselspital), Bern, Switzerland;9. Division of General Thoracic Surgery, University Hospital of Bern (Inselspital), Bern, Switzerland;10. Department of Radio-Oncology, Oncology Center, Vevey, Switzerland;11. Department of Oncology, University Hospital of Zurich, Zurich, Switzerland;12. Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland;13. Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland;14. Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland;15. Department of Thoracic Surgery, University Hospital of Basel, Basel, Switzerland;p. Department of Oncology, University Hospital of Geneva, Geneva, Switzerland;q. Department of Oncology, Cantonal Hospital of Graubünden, Graubünden, Switzerland;r. Department of Medical Oncology, Cantonal Hospital of Lucerne, Lucerne, Switzerland;s. Department of Medical Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland |
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| Abstract: | IntroductionLong-term data on outcomes of operable stage III NSCLC are scarce.MethodsIndividual patient data from 368 patients enrolled in one phase III and two phase II trials were pooled and outcomes after applying the eighth (denoted with an asterisk *]) versus the sixth TNM staging edition were compared. Patients were treated with either preoperative radiotherapy following 3 cycles of induction chemotherapy (trimodal) or neoadjuvant chemotherapy alone (bimodal).ResultsWith the sixth version, the 5- and 10-year survival rates were 38% and 28% for stage IIIA, respectively, and 36% and 24% for stage IIIB, respectively. Factors associated with improved 5-year overall survival were younger age, R0 resection, and pathologic complete remission (pCR) (p = 0.043, p < 0.001 and p = 0.009). With the eighth 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*, respectively, and 35% and 27% for stage IIIB* patients, respectively. There was no difference in the bi- versus trimodal group with regard to median overall survival (28 months 95% confidence interval (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] versus 13 months 95% CI: 10–22 months], p = 0.71).ConclusionsWe showed favorable 10-year survival rates of 29% and 27% in stage IIIA* and IIIB*, respectively. Younger age, R0 resection, and pathologic complete response were associated with improved long-term survival. Outcomes using the sixth versus eighth edition of the TNM classification were similar in operable stage III NSCLC. |
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| Keywords: | Stage III NSCLC Long-term survival Preoperative radiotherapy |
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