Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935

Michael T. Jaklitsch*, James E. Herndon, Malcolm M. Decamp, William G. Richards, Parvesh Kumar, Mark J. Krasna, Mark R. Green, David J. Sugarbaker

*Corresponding author for this work

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background and Objectives: CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung cancer. Induction cisplatin/vinblastine chemotherapy was followed by surgical resection, adjuvant cisplatin/vinblastine, and radiotherapy. We now evaluate the prognosis of pathologic nodes. Methods: Failure-free survival was calculated from a landmark 3 months after resection to account for heterogeneity in adjuvant therapy. Results: Nine of 42 (21%) resected patients had no residual N2 disease. This subset of 9 had a median failure-free interval of 47.8 months from landmark, whereas the 33 patients (79%) with persistent N2 disease had a median failure-free survival of 8.2 months from landmark (P = 0.01). Although 21/42 (50%) had an incomplete resection (positive highest resected node and/or margin), completeness of resection did not influence failure-free survival. There were 3 distant and no local recurrences among the N2 negative group, and 12 local recurrences among patients with residual N2 disease (P = 0.041). Conclusions: These data suggest: (1) persistent N2 disease following induction chemotherapy is unfavorable; (2) patients downstaged to N2 negative may benefit from surgical resection; however, (3) 33% of N2 negative patients suffered disease relapse.

Original languageEnglish (US)
Pages (from-to)599-606
Number of pages8
JournalJournal of Surgical Oncology
Volume94
Issue number7
DOIs
StatePublished - Dec 1 2006

Fingerprint

Induction Chemotherapy
Non-Small Cell Lung Carcinoma
Survival
Vinblastine
Recurrence
Cisplatin
Radiotherapy
Drug Therapy

Keywords

  • Adjuvant chemoradiotherapy
  • Downstage
  • Mediastinoscopy
  • N2 disease
  • Neoadjuvant chemotherapy
  • Stage IIIA NSCLC
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Jaklitsch, M. T., Herndon, J. E., Decamp, M. M., Richards, W. G., Kumar, P., Krasna, M. J., ... Sugarbaker, D. J. (2006). Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935. Journal of Surgical Oncology, 94(7), 599-606. https://doi.org/10.1002/jso.20644
Jaklitsch, Michael T. ; Herndon, James E. ; Decamp, Malcolm M. ; Richards, William G. ; Kumar, Parvesh ; Krasna, Mark J. ; Green, Mark R. ; Sugarbaker, David J. / Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935. In: Journal of Surgical Oncology. 2006 ; Vol. 94, No. 7. pp. 599-606.
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abstract = "Background and Objectives: CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung cancer. Induction cisplatin/vinblastine chemotherapy was followed by surgical resection, adjuvant cisplatin/vinblastine, and radiotherapy. We now evaluate the prognosis of pathologic nodes. Methods: Failure-free survival was calculated from a landmark 3 months after resection to account for heterogeneity in adjuvant therapy. Results: Nine of 42 (21{\%}) resected patients had no residual N2 disease. This subset of 9 had a median failure-free interval of 47.8 months from landmark, whereas the 33 patients (79{\%}) with persistent N2 disease had a median failure-free survival of 8.2 months from landmark (P = 0.01). Although 21/42 (50{\%}) had an incomplete resection (positive highest resected node and/or margin), completeness of resection did not influence failure-free survival. There were 3 distant and no local recurrences among the N2 negative group, and 12 local recurrences among patients with residual N2 disease (P = 0.041). Conclusions: These data suggest: (1) persistent N2 disease following induction chemotherapy is unfavorable; (2) patients downstaged to N2 negative may benefit from surgical resection; however, (3) 33{\%} of N2 negative patients suffered disease relapse.",
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Jaklitsch, MT, Herndon, JE, Decamp, MM, Richards, WG, Kumar, P, Krasna, MJ, Green, MR & Sugarbaker, DJ 2006, 'Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935', Journal of Surgical Oncology, vol. 94, no. 7, pp. 599-606. https://doi.org/10.1002/jso.20644

Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935. / Jaklitsch, Michael T.; Herndon, James E.; Decamp, Malcolm M.; Richards, William G.; Kumar, Parvesh; Krasna, Mark J.; Green, Mark R.; Sugarbaker, David J.

In: Journal of Surgical Oncology, Vol. 94, No. 7, 01.12.2006, p. 599-606.

Research output: Contribution to journalArticle

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T1 - Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935

AU - Jaklitsch, Michael T.

AU - Herndon, James E.

AU - Decamp, Malcolm M.

AU - Richards, William G.

AU - Kumar, Parvesh

AU - Krasna, Mark J.

AU - Green, Mark R.

AU - Sugarbaker, David J.

PY - 2006/12/1

Y1 - 2006/12/1

N2 - Background and Objectives: CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung cancer. Induction cisplatin/vinblastine chemotherapy was followed by surgical resection, adjuvant cisplatin/vinblastine, and radiotherapy. We now evaluate the prognosis of pathologic nodes. Methods: Failure-free survival was calculated from a landmark 3 months after resection to account for heterogeneity in adjuvant therapy. Results: Nine of 42 (21%) resected patients had no residual N2 disease. This subset of 9 had a median failure-free interval of 47.8 months from landmark, whereas the 33 patients (79%) with persistent N2 disease had a median failure-free survival of 8.2 months from landmark (P = 0.01). Although 21/42 (50%) had an incomplete resection (positive highest resected node and/or margin), completeness of resection did not influence failure-free survival. There were 3 distant and no local recurrences among the N2 negative group, and 12 local recurrences among patients with residual N2 disease (P = 0.041). Conclusions: These data suggest: (1) persistent N2 disease following induction chemotherapy is unfavorable; (2) patients downstaged to N2 negative may benefit from surgical resection; however, (3) 33% of N2 negative patients suffered disease relapse.

AB - Background and Objectives: CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung cancer. Induction cisplatin/vinblastine chemotherapy was followed by surgical resection, adjuvant cisplatin/vinblastine, and radiotherapy. We now evaluate the prognosis of pathologic nodes. Methods: Failure-free survival was calculated from a landmark 3 months after resection to account for heterogeneity in adjuvant therapy. Results: Nine of 42 (21%) resected patients had no residual N2 disease. This subset of 9 had a median failure-free interval of 47.8 months from landmark, whereas the 33 patients (79%) with persistent N2 disease had a median failure-free survival of 8.2 months from landmark (P = 0.01). Although 21/42 (50%) had an incomplete resection (positive highest resected node and/or margin), completeness of resection did not influence failure-free survival. There were 3 distant and no local recurrences among the N2 negative group, and 12 local recurrences among patients with residual N2 disease (P = 0.041). Conclusions: These data suggest: (1) persistent N2 disease following induction chemotherapy is unfavorable; (2) patients downstaged to N2 negative may benefit from surgical resection; however, (3) 33% of N2 negative patients suffered disease relapse.

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KW - N2 disease

KW - Neoadjuvant chemotherapy

KW - Stage IIIA NSCLC

KW - Survival

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