Neoadjuvant chemoradiation and surgery improves survival outcomes compared with definitive chemoradiation in the treatment of stage IIIA N2 XXXX

@entity1 @entity1149 @entity420 @entity204
OBJECTIVES: The objective of this study was to compare survival in @entity1 with stage IIIA (N2) @entity1149 ( @entity1149 ) treated with definitive chemoradiation (CRT) or surgery plus neoadjuvant chemoradiation or chemotherapy (CRTS). METHODS: A retrospective analysis of 242 @entity1 with stage IIIA (N2) @entity1149 treated with curative intent between 1997 and 2007, identified 215 @entity1 with surgically resectable disease. Overall survival outcomes were analysed using the Kaplan-Meier plots, log-rank tests and Cox proportional hazards models adjusting for age, gender, histology, smoking history and performance status. Recurrences were compared using competing risks methods, including the proportional subdistribution hazards regression model. RESULTS: CRTS was used to treat 104 @entity1 and CRT in 111. Comparing CRTS with CRT @entity1 , median age was 60 vs 62, 50 (48%) vs 69 (62%) were male and 65 (62.5%) vs 60 (54%) had @entity420 . Of CRTS @entity1 , 83 (80%) had a lobectomy. CRTS @entity1 compared with CRT @entity1 had decreased risk of recurrence at any site [hazard ratio (HR) = 0. 46, 95% confidence interval (CI): 0.32-0.64 P < 0.0001], local recurrence (HR = 0.50, 95% CI: 0.29-0.87, P = 0.013), loco--regional recurrence (HR = 0.51, 95% CI: 0.33-0.78, P = 0.002) and @entity204 (HR: 0.45, 95% CI: 0.33-0.62, P < 0.0001) with a median survival of 4.2 years vs 1.7 years). Risk of distant recurrence was also reduced in the surgical group (HR: 0.57; 95% CI: 0.38-0.87, P = 0.017). Treatment-related mortality was low in both cohorts. CONCLUSION: For @entity1 with surgically resectable stage IIIA (N2) @entity1149 , neoadjuvant therapy plus surgery reduces loco-regional and distant recurrence and improves survival. Treatment-related mortality was not significantly increased compared with the @entity1 treated with CRT alone.
