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 language | English (US) |
|---|---|
| Pages (from-to) | 599-606 |
| Number of pages | 8 |
| Journal | Journal of Surgical Oncology |
| Volume | 94 |
| Issue number | 7 |
| DOIs | |
| State | Published - Dec 1 2006 |
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Keywords
- Adjuvant chemoradiotherapy
- Downstage
- Mediastinoscopy
- N2 disease
- Neoadjuvant chemotherapy
- Stage IIIA NSCLC
- Survival
ASJC Scopus subject areas
- Surgery
- Oncology
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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 journal › Article
TY - JOUR
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.
KW - Adjuvant chemoradiotherapy
KW - Downstage
KW - Mediastinoscopy
KW - N2 disease
KW - Neoadjuvant chemotherapy
KW - Stage IIIA NSCLC
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=33845208606&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33845208606&partnerID=8YFLogxK
U2 - 10.1002/jso.20644
DO - 10.1002/jso.20644
M3 - Article
VL - 94
SP - 599
EP - 606
JO - Journal of Surgical Oncology
JF - Journal of Surgical Oncology
SN - 0022-4790
IS - 7
ER -