Stage IIIA non-small cell lung cancer: morbidity and mortality of three distinct multimodality regimens

Background: Although concurrent chemoradiation therapy can cure stage IIIA non-small cell lung cancer (NSCLC), studies have demonstrated that anatomic resection following high-dose or standard-dose chemoradiation may benefit selected patients. We examined morbidity and mortality associated with 3 multimodality treatment regimens for stage IIIA disease.

Methods: Institutional databases identified patients with stage IIIA (N2) NSCLC who underwent concurrent platinum-based chemoradiotherapy with or without pulmonary resection between 1998 and 2011. Exclusion criteria included palliative regimens, sequential chemoradiotherapy, radiation-surgery interval greater than 12 weeks, superior sulcus tumors, or radiotherapy other than standard external beam radiation. Treatment-related morbidity and mortality were examined for the following treatment regimens: neoadjuvant chemoradiotherapy with 45 Gy followed by surgery (trimodality-45); neoadjuvant chemoradiotherapy with 60 Gy or more followed by surgery (trimodality-60); and definitive chemoradiotherapy with 60 Gy or more without surgery (D-CRT).

Results: During the study period, 144 patients met eligibility criteria including 27 trimodality-45, 29 trimodality-60, and 88 D-CRT patients. Treatment-related morbidity and mortality rates for D-CRT were 74% [65 of 88] and 2.3% [2 of 88], respectively. Postoperative morbidity and mortality rates for patients who proceeded to surgery were 48% [27 of 56] and 1.8% [1 of 56], respectively, and did not differ based on dose of neoadjuvant radiation. Despite varied anatomic resections and methods of bronchial closure and coverage, no bronchopleural fistulae were observed.

Conclusions: Chemoradiotherapy carries a significant morbidity profile. However, high-dose neoadjuvant radiation is not associated with increased postoperative morbidity or mortality relative to standard-dose radiation in patients selected for anatomic resection.