Nav: Home

Surgery timing after neoadjuvant chemoradiation in Stage IIIA NSCLC impacts OS

October 05, 2016

The timing of surgery after neoadjuvant chemoradiation in patients with stage IIIA non-small cell lung cancer (NSCLC) affects the overall survival of patients receiving trimodality therapy.

Approximately one third of all NSCLC patients have locally advanced (stage III, subtypes IIIA and IIIB) disease at the time of diagnosis, with a five-year survival ranging from 7 to 19%. Patients with stage III NSCLC represent a significant clinical challenge due to the poor prognosis associated with this stage of disease. Trimodality therapy involving the use of radiation concurrently with chemotherapy, otherwise known as neoadjuvant chemoradiation therapy (NCRT), followed by surgery is an acceptable treatment strategy for stage IIIA patients with resectable tumors and limited mediastinal node (N2) involvement. However, trimodality therapy has not been shown to have significant survival advantage over definitive chemoradiation therapy and the optimal interval to surgery (ITS) after completion of NCRT has not been well explored.

A group of investigators conducted a retrospective analysis to examine whether the ITS after completion of NCRT correlates with survival outcomes in clinical stage IIIA, T1-3 N2 NSCLC patients using patient records between 2004 and 2013 from the National Cancer Database (NCDB). Patients were categorized based on the interval between chemoradiation and surgery (0 - ?3 weeks, 3 - ?6 weeks, 6 - ?9 weeks, and 9 - ?12 weeks). Patients with stage IIIB and other clinical stages were excluded from this study. Overall survival (OS) was examined using Kaplan-Meier method and log-rank tests and bootstrapped Cox proportional hazards model was used to determine significant contributors to OS.

The results of the study published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC), showed that of the 1,623 NSCLC patients identified with clinical stage IIIA, T1-3 N2 disease, 7.9% underwent surgery at 0 - ?3 weeks, 50.5% underwent surgery 3 - ?6 weeks, 31.9% underwent surgery 6 - ?9 weeks, and 9.6% underwent surgery 9 - ?12 weeks after NCRT. In the univariate analysis, there was no significant difference in OS between the patients that underwent surgery at 0 - ?3 weeks or 3 - ?6 weeks. Decreasing OS was observed in patients that underwent surgery at 6 - ?9 weeks and patients that underwent surgery 9 - ?12 weeks fared significantly worse than those patients that had surgery at 0 - ?3 weeks after NCRT. Multivariate analysis, which accounted for patients receiving lobectomy verses pneumonectomy, showed no significant difference in OS for patients who underwent surgery within 6 weeks of NCRT. However, a significant decrease in OS was observed in patients who had surgery 6 - ?9 weeks (HR: 1.33, 95% CI: 1.01-1.76, P=0.043) and 9 - ?12 weeks (HR: 1.44, 95% CI: 1.04-2.01, P=0.030) after NCRT.

The authors comment that, "The results of our study suggest that waiting greater than 6 weeks to have surgery after NCRT may negatively impact both perioperative mortality and OS. This finding concurs with prior data that recommend an ITS following NCRT of less than 8 weeks. Minimizing the time between NCRT and surgery is thought to improve outcomes because it reduces the risks associated with operating in the presence of radiation pneumonitis. Although radiation may affect surgical outcomes anywhere between 3 and 12 weeks, it is particularly troublesome at the tail end of that interval when a patient is at highest risk for the development of fibrosis, narrowing of the pulmonary vessels, microvascular thrombosis, and collagen deposition by fibroblasts into the interstitium, increasing the risk for postoperative complications."
Co-authors Frank Detterbeck, Daniel Boffa, Roy Decker, and Anthony Kim are members of IASLC.

About the IASLC

The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated to the study of lung cancer. Founded in 1974, the association's membership includes more than 5,000 lung cancer specialists in over 100 countries. Visit for more information.

Written by: Jacinta Wiens, PhD, 720-598-1941;

Media Contact: Becky Bunn, 720-254-9509;

International Association for the Study of Lung Cancer

Related Lung Cancer Articles:

AI helps to fight against lung cancer
Lung cancer has been the leading cause of cancer-related deaths in 2015 in United States.
Free lung-cancer screening in the Augusta area finds more than double the cancer rate of previous screenings
The first year of free lung cancer screening in the Augusta, Ga., area found more than double the rate seen in a previous large, national study as well as a Massachusetts-based screening for this No.
Antioxidants and lung cancer risk
An epidemiological study published in Frontiers in Oncology suggests that a diet high in carotenoids and vitamin C may protect against lung cancer.
Lung cancer may go undetected in kidney cancer patients
Could lung cancer be hiding in kidney cancer patients? Researchers with the Harold C.
Hitgen and Cancer Research UK's Manchester Institute enter license agreement in lung cancer
Cancer Research UK, Cancer Research Technology (CRT), the charity's commercial arm, and HitGen Ltd, a privately held biotech company focused on early drug discovery, announced today that they have entered into a licence agreement to develop a novel class of drugs against lung cancer.
Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
Huntsman Cancer Institute research holds promise for personalized lung cancer treatments
New research from scientists at Huntsman Cancer Institute (HCI) at the University of Utah uncovered distinct types of tumors within small cell lung cancer that look and act differently from one another.
High levels of estrogen in lung tissue related to lung cancer in postmenopausal women
Researchers from Kumamoto University, Japan have found that postmenopausal women with multicentric adenocarcinoma of the lung have a higher concentration of estrogen in non-cancerous areas of the peripheral lung than similar women diagnosed with single tumor lung cancer.
Radiotherapy for lung cancer patients is linked to increased risk of non-cancer deaths
Researchers have found that treating patients who have early stage non-small cell lung cancer with a type of radiotherapy called stereotactic body radiation therapy is associated with a small but increased risk of death from causes other than cancer.
Pericardial window operation less efficient in cases of lung cancer than any other cancer
Pericardial window operation, a procedure, where abnormal quantity of malignant fluid, surrounding the heart, is drained into the neighbouring chest cavity, is commonly applied to patients diagnosed with cancer.

Related Lung Cancer Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#530 Why Aren't We Dead Yet?
We only notice our immune systems when they aren't working properly, or when they're under attack. How does our immune system understand what bits of us are us, and what bits are invading germs and viruses? How different are human immune systems from the immune systems of other creatures? And is the immune system so often the target of sketchy medical advice? Those questions and more, this week in our conversation with author Idan Ben-Barak about his book "Why Aren't We Dead Yet?: The Survivor’s Guide to the Immune System".