Impact of neoadjuvant chemoradiotherapy followed by surgical resection on node-negative T3 and T4 XXXX .

@entity1 @entity1149 @entity204 @entity5
OBJECTIVE: This study examined the impact of neoadjuvant chemotherapy and concurrent high-dose radiation therapy on survival in @entity1 with node-negative T3 and T4 @entity1149 . METHODS: A total of 110 consecutive @entity1 underwent surgical resection for invasive T3N0M0 (94 @entity1 ) and T4N0M0 (16 @entity1 ) @entity1149 between 1979 and 2008. Forty-seven @entity1 received neoadjuvant chemotherapy and concurrent high-dose (5940 cGy) radiation therapy before resection (Chemo-RT group). Sixty-three @entity1 underwent surgical resection without receiving induction chemoradiotherapy (Surg group), of whom 21 received neoadjuvant radiation, 19 received adjuvant radiation, 17 received surgery alone, 2 received adjuvant chemotherapy, 2 received adjuvant chemoradiotherapy, and 2 received brachytherapy. Survival of the Chemo-RT and Surg groups was compared using both crude and adjusted Cox proportional hazards models. RESULTS: The 5-year, 10-year, and median survivals were 61%, 50%, and 90 months, respectively, in the Chemo-RT group versus 22%, 14%, and 22 months, respectively, in the Surg group. Subjects in the Surg group had an increased risk of @entity204 (hazard ratio, 2.60; 95% confidence interval, 1.62-4.18; P  =  .0001) compared with the Chemo-RT group. After adjustment for potential confounding variables of age, sex, @entity5 size, @entity5 location, type of operation, and decade of care, subjects in the Surg group remained at increased risk of @entity204 (hazard ratio, 2.81; 95% confidence interval, 1.45-5.44, P  =  .002) compared with the Chemo-RT group. CONCLUSIONS: Aggressive treatment of node-negative invasive T3 and T4 NSCLC with induction chemoradiotherapy may significantly prolong survival. This approach should be evaluated in a prospective multicenter national trial.
