Does dose matter? Effect of two different neoadjuvant protocols in advanced NSCLC

• Published in: The Thoracic and cardiovascular surgeon Vol. 61; no. 2; p. 109
• Main Authors: Steger, Volker, Veit, Stefanie, Walker, Tobias, Friedel, Godehard, Lehrach, Karoline, Mustafi, Migdat, Walles, Thorsten
• Format: Journal Article
• Language: English
• Published: Germany 01.03.2013
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - therapy; Chemoradiotherapy, Adjuvant - adverse effects; Chemoradiotherapy, Adjuvant - mortality; Chi-Square Distribution; Dose-Response Relationship, Drug; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Middle Aged; Neoadjuvant Therapy - adverse effects; Neoadjuvant Therapy - mortality; Neoplasm Staging; Pneumonectomy; Proportional Hazards Models; Radiation Dosage; Retrospective Studies; Time Factors; Treatment Outcome
• ISSN: 1439-1902
• DOI: 10.1055/s-0032-1311529

For stage III, NSCLC neoadjuvant protocols have been intensified up to full dose protocols but up till now the effect of more intensive protocols in a trimodal setting could not be compared directly because of different selection criteria or experience of involved facilities in different studies or multicenter studies. We analyzed our experience with two different neoadjuvant protocols, consistent selection criteria, and surgical teams over 17-year time period. Single-center retrospective study in 159 patients concerning survival, recurrence, and downstaging effect. Overall median survival was 32 months, with 26 months for protocol 1, and 35 months for protocol 2, respectively. Hospital mortality was 5%. Log-rank test showed significant difference between the protocols for UICC-downstaging-effect, ypT-stage, ypN-stage, and ypUICC-stage, respectively, but only ypN-stage and ypUICC-stage were significant risk factors for survival using Cox regression. The median survival benefit of 9 months is evident but (probably still) not significant. The more aggressive protocol 2 shows a significant better downstaging effect concerning N- and UICC-stage if R0-resection can be achieved. Insofar dose does matter!