ASTRO 2017: Trimodality Therapy Versus Concurrent Chemoradiation in Advanced NSCLC
Annemarie Fernandez Shepherd, MD, of the Memorial Sloan Kettering Cancer Center, New York, and colleagues found both trimodality therapy and definitive concurrent chemoradiation in patients with stage IIIA non–small cell lung cancer (NSCLC) with mediastinal involvement delivered similar rates of distant metastasis–free survival. However, fitness and disease characteristics of the two patient populations may have played a role in the superior overall and progression-free survival in the trimodality arm. The study was presented at the 2017 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 3174).
The investigators retrospectively analyzed 267 patients, about half of whom were treated with trimodality therapy and the other half with concurrent chemoradiation therapy. More patients in the chemoradiation therapy group were current smokers with larger tumors and demonstrated more advanced disease characteristics.
The trimodality group showed superior progression-free survival (44% vs. 29%), overall survival (69% vs. 46%), and local-regional control (76% vs. 58%). Both groups demonstrated similar distant metastasis–free survival (46% vs. 41%). However, in subsets of patients with subcarinal involvement or extensive mediastinal involvement, trimodality therapy did not result in superior rates of overall survival, progression-free survival, or local-regional control.
The authors concluded that determining the optimal treatment paradigm for patients with mediastinal advanced NSCLC may require future prospective trials to control for disease and patient cofounders.