Abstract
BackgroundStandard therapy for stage III non-small cell lung cancer with chemotherapy and conventional radiation has suboptimal outcomes. We hypothesized that a combination of surgery followed by stereotactic body radiation therapy (SBRT) would be a safe alternative.MethodsPatients with stage IIIA (multistation N2) or IIIB non-small cell lung cancer were enrolled from March 2013 to December 2015. The protocol included transcervical extended mediastinal lymphadenectomy (TEMLA) followed by surgical resection, 10 Gy SBRT directed to the involved mediastinum/hilar stations and/or positive surgical margins, and adjuvant systemic therapy. Patients not suitable for anatomic lung resection were treated with 30 Gy to the primary tumor. The primary efficacy end-point was the proportion of patients with grade 3 or higher adverse events (AE) or toxicities.ResultsOf 10 patients, 7 patients underwent neoadjuvant chemotherapy. All patients had TEMLA. Nine of 10 patients underwent surgical resection. The remaining patient had an unresectable tumor and received 30 Gy SBRT to the primary lesion. All patients had post-operative SBRT. Median follow-up was 18 months. There were no perioperative mortalities. Six patients had any grade 3 AEs with no grade 4–5 AEs. Of these, 4 were not attributable to radiation. Pulmonary-related grade 3 AEs were experienced by 2 patients. There were no failures within the 10 Gy volume. Overall survival and progression-free survival rates at 2 years were 68% (90% CI 36–86) and 40% (90% CI 16–63), respectively.ConclusionsIn carefully selected patients with locally advanced non-small cell lung cancer, combining surgery with SBRT was well tolerated with no local failure.Trial registrationClinicalTrials.gov identifying number NCT01781741. Registered February 1, 2013.
Highlights
Standard therapy for stage III non-small cell lung cancer with chemotherapy and conventional radiation has suboptimal outcomes
The remaining 10 patients with stage IIIA or IIIB non-small cell lung cancer (NSCLC) were enrolled in the study
Compared to the baseline, there appears to be no significant change seen in any measure of pulmonary function during follow-up. This is the first report of a planned prospective study combining discretionary neoadjuvant chemotherapy, followed by limited surgery (VATS and transcervical extended mediastinal lymphadenectomy (TEMLA)) followed by stereotactic body radiation therapy (SBRT) followed by adjuvant chemotherapy in locally advanced NSCLC
Summary
Standard therapy for stage III non-small cell lung cancer with chemotherapy and conventional radiation has suboptimal outcomes. We hypothesized that a combination of surgery followed by stereotactic body radiation therapy (SBRT) would be a safe alternative. The standard of care for unresectable stage III non-small cell lung cancer (NSCLC) remains concurrent chemoradiation [1, 2]. Even among patients with excellent performance status and limited disease-related weight loss prior to their treatments, the 5-year overall survival remains 16% with significant toxicity [1, 2]. When compared to conventionally fractionated radiation therapy as used in chemoradiation, stereotactic body radiation therapy (SBRT) has equivalent survival and local control with less toxicity, improved quality of life, and shortened duration of treatment in patients with early stage NSCLC [6].
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