EP1.18-23 Is Salvage Lung Resection Necessary After Definitive Chemoradiation Therapy for Stage IIIA(N2) Non-Small Cell Lung Cancer?

Abstract

A combination of platinum-based chemotherapy and definitive radiotherapy is the standard of care for Stage III (N2) NSCLC patients who have single or multiple lymph node metastasis. However, the role of salvage lung resection in patients with residual disease without lymph node metastasis is yet to be identified. Between January 2011 and December 2018 103 eligible patients who had pathologically proven in two university hospital clinics, stage IIIA/N2 non-small-cell lung cancer and were prospectively recorded. Those in the chemoradiotherapy group received three cycles of neoadjuvant chemotherapy (AUCx2 carboplatin and docetaxel 85 mg/m[2 ] docetaxel) and concurrent radiotherapy with 61.2-64.0 Gy in 34 fractions over 3 weeks followed by surgical resection. Also, a group of patients who had definitive chemoradiotherapy who did not undergo surgery was compared with the surgical group. A total of 103 patients were analyzed, of whom 75(72.8%) received chemoradiotherapy followed by surgical resection and 28(27.2) had chemoradiotherapy only. Median overall survival was 49 months (95% CI 8.0–58.0) in the chemoradiotherapy + surgery group and 33.0 months (95% CI:7.5–90.4) in the chemotherapy group (p=0.423). One patients died in the surgery group within 30 days(0.9%) after surgery. Complication rate in all patients and the patients who underwent pneumonectomy after chemoradiation were not statistically significantly different compared to those who had undergone resectional surgery without oncological therapy(p=0.321, p=0.08 respectively). Pulmonary salvage resection after definitive chemoradiotherapy is safe and surgical resection after chemoradiotherapy did not seem to provide better survival in histologically proven N2 stage IIIA non-small cell lung cancer.