P2.02-041 The Impact of Surgical Resection after Concurrent Chemotherapy and High Dose (61 Gy) Radiation in Stage IIIA/N2 Non-Small Cell Lung Cancer

Abstract

Locally advanced stage IIIA non-small-cell lung cancer with N2 disease is the most advanced stage at which cure can be achieved, but more than 60% of patients eventually die from their disease. For patients with stage IIIA/N2 disease, two standard treatment options are offered: definitive concurrent chemoradiotherapy or surgery combined with chemo/radiotherapy. We aimed to investigate the role of surgery after concurrent chemotherapy and high dose radiation in patients with N2 disease. Between January 2011 and December 2015 eligible patients had pathologically proven, stage IIIA/N2 non-small-cell lung cancer and were prospectively recorded. Those in the chemoradiotherapy group received three cycles of neoadjuvant chemotherapy (AUCx2 carpoplatin and docetaxel 85 mg/m2 docetaxel) and concurrent radiotherapy with 61.2 Gy in 34 fractions over 3 weeks followed by surgical resection, and those in the control group received definitive chemoradiotherapy alone. All patients in two groups were proven to have no N2 disease after chemoradiotherapy. A total of 58 patients were enrolled, of whom 21 received chemoradiotherapy followed by surgical resection and 37 had chemoradiotherapy only. Median overall survival was 35 months (95% CI 10.5–44.0) in the chemoradiotherapy + surgery group and 20.3 months (4.5–38.6) in the chemotherapy group (p=0.03). Median overall survival was 37.1 months (95% CI 22.6–50.0) with radiotherapy, compared with 26.2 months (19.9–52.1) in the control group. One patients died in the surgery group within 30 days after surgery. Pulmonary resection after high-dose neoadjuvant chemoradiotherapy is safe and surgical resection after chemoradiotherapy may provide better survival in histologically proven N2 stage IIIA non-small cell lung cancer.