Concurrent paclitaxel-based chemo-radiotherapy for post-surgical microscopic residual tumor at the bronchial margin (R1 resection) in non-small-cell lung cancer.

You Lu,Zhenyu Ding,Li Ren,Meixiang Zhou,Tao Li,Changjin Sun,Na Li,Feng Peng,Youling Gong,Meijuan Huang,Jiang Zhu,Yong Xu,Yongmei Liu,Yongsheng Wang,Jin Wang

doi:10.1186/s12885-015-1036-0

Abstract

BackgroundThe microscopic residual tumor at the bronchial margin after radical surgery (R1 resection) affects prognosis negatively in non-small-cell lung cancer (NSCLC) patients. For patients with good performance status, a potential cure still exists. Here, we report the outcomes of concurrent paclitaxel-based chemo-radiotherapy (CRT) for NSCLC patients with microscopically positive bronchial margins or peribronchial infiltration.MethodsA retrospective search in the clinical database was conducted in three hospitals. Patients were identified and evaluated if treated with radiotherapy combined with paclitaxel-based chemotherapy. The objects analyzed were local control time, progression-free survival (PFS), overall survival (OS), and treatment-related toxicity.ResultsSixty-one patients with microscopic residual tumor at the bronchial stump following pulmonary lobectomy were identified. Forty-six patients who had received concurrent paclitaxel-based CRT were analyzed. The median follow-up was 40 months (range: 15.0–77.5 months). The 1-, 2- and 3-year survival rates were 97.8%, 60.9% and 36.9%, respectively. The local recurrences were recorded in 19.6% (9/46) patients. Median PFS and OS for the evaluated cohort were 23.0 [95% confidence interval (CI): 21.3–24.7] and 32.0 (95% CI: 23.7–40.3) months, respectively. The most common side effects were hematological toxicity (neutropenia, 93.5%; anemia, 89.1%; and thrombocytopenia, 89.1%) and no treatment-related deaths. Grade ≥2 acute radiation-induced pneumonitis and esophagitis were recorded in 43.5% (20/46) and 26.1% (12/46) patients, respectively. By univariate analysis, non-squamous cell lung cancer was associated with a significantly longer survival time (45.1 vs 26.4 months, p = 0.013).ConclusionsFor NSCLC patients with post-surgical microscopic residual tumor at the bronchial stump, concurrent paclitaxel-based chemo-radiotherapy achieved promising outcomes with accepted treatment-related toxicity.

Highlights

The microscopic residual tumor at the bronchial margin after radical surgery (R1 resection) affects prognosis negatively in non-small-cell lung cancer (NSCLC) patients
We retrospectively evaluated the clinical outcomes of patients treated with curative-intent CRT, giving detailed information of the survival and related side effects, with the intention of proving suitable treatment for patients after R1 resection at the bronchial margin
Patient data R1 resection was defined as invasive microscopic residual tumor at the bronchial margin, or peribronchial infiltration without any tumor lesion at the bronchial stump area at baseline computed tomography (CT) 4 weeks after surgery

Summary

Introduction

The microscopic residual tumor at the bronchial margin after radical surgery (R1 resection) affects prognosis negatively in non-small-cell lung cancer (NSCLC) patients. We report the outcomes of concurrent paclitaxel-based chemo-radiotherapy (CRT) for NSCLC patients with microscopically positive bronchial margins or peribronchial infiltration. Anatomic pulmonary lobectomy with radical lymph node dissection is the primary treatment for operable non-small-cell lung cancer (NSCLC) [1]. The incidence of microscopic residual tumor at the bronchial margin (R1 resection) is 4–5% The classification of an R1 resection at the bronchial margin is not uniform in the literature, Wind et al concluded that it could be divided into submucosal residual disease, peribronchial residual disease, and extrabronchial residual disease [2]. Microscopic residual tumor might negatively affect prognosis, with 1- and 5-year survival rates among these patients between 20-50% and 0–20%, respectively [2]. The panel of the National Comprehensive Cancer Network (NCCN) still recommended that repeat

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