OA20.05 Neoadjuvant Chemotherapy-alone vs Chemoradiation followed by Sleeve Resection for Locally Advanced Non-Small Cell Lung Cancer

Abstract

Traditionally, neoadjuvant chemoradiation is followed by surgery in patients with locally advanced resectable non-small cell lung cancer (NSCLC). The risks and benefits of this approach are not well defined in patients requiring a sleeve lung resection. In this context, we compare the short- and long-term outcomes of neoadjuvant chemotherapy-alone versus chemoradiation followed by sleeve lung resection. We used the National Cancer Database to identify locally advanced NSCLC patients who received either chemotherapy-alone or chemoradiation in the neoadjuvant setting followed by a sleeve lung resection between 2006 and 2017. Our outcomes of interest were 30-day mortality, 90 day mortality, and overall survival. To minimize confounding by indication, we used propensity score adjustment, logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards models to identify associations. Of 176 total patients, 92 (54.9%) received neoadjuvant chemotherapy-alone and 84 (45.1%) received neoadjuvant chemoradiation. Patients in both groups were well balanced in terms of age, sex, race, Charlson-Deyo comorbidity index, insurance status, median income, and education (all p>0.05). Similarly, the groups were well balanced in terms of tumor histology, and stage (all p>0.05). Patients receiving neoadjuvant chemoradiation had similar 30-day mortality (0% vs 2.2%; p=0.179), but higher 90-day mortality (11.96% vs 2.38%, P=0.015), and there was no difference in overall survival between patients receiving neoadjuvant chemoradiation compared to chemotherapy-alone (Figure; p=0.621). On multivariable analysis, neoadjuvant chemoradiation was associated with higher 90 day mortality (aOR=6.2; p<0.027) and not associated with overall survival (aHR=1.1 p=0.729). In this first national study of patients with locally advanced resectable NSCLC requiring a sleeve lung resection, neoadjuvant chemoradiation was associated with a 5-fold increase in 90-day mortality without an overall survival benefit over neoadjuvant chemotherapy-alone.