Induction Chemoradiotherapy Followed by Resection May Benefit Some Patients With NSCLC of the Superior Sulcus


Key Points

  • Complete or partial combined response was achieved in over 57% of patients receiving induction chemoradiotherapy and resection, according to final study analysis. 
  • For all patients receiving induction chemoradiotherapy and resection, median overall survival was 22.6 months.
  • The brain was the most common metastatic relapse site.

In a retrospective study of patients with non–small cell lung cancer (NSCLC) of the superior sulcus, induction chemoradiotherapy followed by resection provided complete or partial response in over 50% of subjects, according to a report by Truntzer et al in Radiation Therapy. However, the investigators reported a high risk of brain metastasis in patients with controlled disease.

Although rare, NSCLC of the superior sulcus is one of the most difficult tumors to treat because of the involvement of adjacent vital structures, including the brachial plexus, subclavian vessels, and spine. Although the current treatment approach for late-stage NSCLC centers on induction chemoradiotherapy followed by resection, the efficacy and safety of this approach in patients with superior sulcus NSCLC have not been well studied.

With that in mind, Truntzer and colleagues conducted a retrospective study of the benefit of induction chemoradiotherapy followed by resection in patients with NSCLC of the superior sulcus. Their main goal was to determine the factors associated with overall survival according to different treatment approaches.

Study Details

In total, the medical records of 42 patients with superior sulcus NSCLC were analyzed. Mean age at diagnosis of these patients, of whom 31 were male and 11 female, was 54.7 years. WHO performance status was 0 or 1 for 82.5% of the patients and 2 for 16.7% of the patients. Patients had been treated either with neoadjuvant or exclusive radiotherapy with or without chemotherapy for stage IIB to IIIB superior sulcus NSCLC.

Patients received preoperative chemoradiotherapy or radiotherapy or a combination of chemoradiotherapy and radiotherapy. Overall, patients received platinum-based doublets: a combination of cisplatin and vinorelbine or a combination of carboplatin and paclitaxel.

Surgery was performed within a mean period of 9.5 weeks (range = 6.8–12.9) after the completion of radiation therapy. It consisted of resection lobectomy, along with mediastinal lymph node dissection.

The response to treatment was considered complete if there was radiologic absence of the measurable disease. Partial response was defined as a regression of more than 50% to the base line of the sum of the perpendicular diameters of all measurable disease.

Complete or Partial Combined Response in Over 57% of Patients

Final analysis indicated that complete or partial combined response was achieved in over 57% of patients. For all patients, median overall survival was 22.6 months. For just those patients who had undergone surgery, median overall survival was 24 months. One-, 2-year, and 5-year overall survival rates were 63.6%, 54.2%, and 37.5%, respectively. In those patients who received chemotherapy/radiotherapy exclusively, median overall survival was 13.3 months. The 1-year, 2-year, and 5-year overall survival rates were 60%, 35%, and 25%, respectively.

For those patients who experienced complications post treatment, 40% were diagnosed with local relapse, 10% were diagnosed with regional relapse, and 25% were diagnosed with metastatic disease. The most common site for metastatic relapse was the brain. Thirteen patients (59%) had postoperative complications, including neuropathic pain (27.3%), respiratory distress (13.6%), and lung infection (13.6%). No patients died postoperatively.

As for associated side effects, 15 patients had chemotherapy-related toxicities. In addition, 13 patients had hematoxicity, and 6 patients experienced febrile neutropenia.

Closing Thoughts

According to the investigators, the results of this study were comparable to previously published retrospective studies, in that complete and partial pathologic responses were obtained in over 57% of patients. In addition, relapse rates after surgery remained low (14.3%) and were comparable with the rates seen in previous studies.

The investigators noted, “We have showed that, following closely the treatment guidelines, complete resection can be achieved and complete pathologic response is obtainable.”  

Georges Noël, MD, PhD, of the Radiotherapy Department, Centre Paul Strauss, Strasbourg University, Strasbourg, France, is the corresponding author of this article in Radiation Oncology.

The study authors reported no potential conflicts of interest.

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