Neoadjuvant Chemotherapy vs Chemoradiation followed by Sleeve Resection for Resectable Lung Cancer. Journal Article

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Authors: Jaradeh, M; Vigneswaran, WT; Raad, W; Lubawski, J; Freeman, R; Abdelsattar, ZM
Article Title: Neoadjuvant Chemotherapy vs Chemoradiation followed by Sleeve Resection for Resectable Lung Cancer.
Abstract: BACKGROUND: Traditionally, neoadjuvant chemoradiation is followed by surgery in patients with locally advanced non-small cell lung cancer (NSCLC). The risks and benefits of this approach are not well defined in patients requiring a sleeve lung resection. In this context, we compare the short- and long-term outcomes of neoadjuvant chemotherapy-alone versus chemoradiation followed by sleeve lung resection. METHODS: We used the National Cancer Database to identify locally advanced NSCLC patients who received either chemotherapy-alone or chemoradiation in the neoadjuvant setting followed by a sleeve lung resection between 2006 and 2017. Our outcomes of interest were 30-day mortality, 90-day mortality, and overall survival. To minimize confounding by indication, we used propensity score adjustment, logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards models to identify associations. RESULTS: Of 176 total patients undergoing sleeve lung resection, 92 (52.3%) received neoadjuvant chemotherapy-alone and 84 (47.7%) received neoadjuvant chemoradiation. Patients in both groups were well balanced in terms of their age, sex, race, Charlson-Deyo comorbidity index, insurance status, median income, and education (all p>0.05). Similarly, the groups were well-balanced in terms of the histology, tumor location, and stage (all p>0.05). Patients receiving neoadjuvant chemoradiation had higher 90-day mortality (11.96% vs 2.38%, P=0.015), and there was no difference in overall survival between the neoadjuvant chemotherapy-alone vs chemoradiation cohorts (p=0.621). CONCLUSIONS: In this first national study of patients with locally advanced resectable NSCLC requiring a sleeve lung resection, neoadjuvant chemoradiation was associated with a 5-fold increase in 90-day mortality without an overall survival benefit over neoadjuvant chemotherapy-alone.
Journal Title: The Annals of Thoracic Surgery
ISSN: 1552-6259; 0003-4975
Publisher: Unknown  
Date Published: 2022