scholarly journals Resection is safe for patients with stage IIIA NSCLC undergoing multimodality therapy

2016 ◽  
Vol 5 ◽  
pp. 22-25
Author(s):  
Entela B. Lushaj ◽  
Walker Julliard ◽  
Traci Bretl ◽  
Abbasali Badami ◽  
Ryan Macke ◽  
...  
Keyword(s):  
Multimodality Therapy ◽  
Stage Iiia ◽  
Iiia Nsclc

scholarly journals Negativation of PD-L1 Postoperatively in Initially Inoperable Stage III Non-Small Cell Lung Cancer Treated with Pembrolizumab: Two Case Reports

2019 ◽  
Vol 12 (2) ◽  
pp. 421-425
Author(s):  
Fadi Nasr ◽  
Ahmad Al Ghoche ◽  
Roland Eid ◽  
Lewis Nasr ◽  
Saada Diab ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Incidental Finding ◽  
Case Reports ◽  
Small Cell ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Iiia Nsclc

Stage III non-small cell lung cancer is a border line stage between localized and metastatic disease. PDL-1 is gaining an important role in the therapeutic arsenal of lung cancer, the most frequent cancer worldwide. We report for the first time a negativation of PDL-1 status in 2 cases of stage IIIA NSCLC with conversion to operable disease after using immunotherapy. The first patient was a 59-year old female diagnosed incidentally to have stage IIIA inoperable NSCLC that was treated with combination chemo-immunotherapy, and converted to operable disease with a negative PD-L1 in the postoperative setting. The second case is that of a 56-year old male that also had an inoperable stage IIIA NSCLC treated with chemotherapy first line followed by pembrolizumab at progression, then operated after surgical conversion, with negative PD-L1 postoperatively. In front of these findings, further work should be done to elucidate if the reverse of the PDL-1 status and the conversion to operability were due to the use of immunotherapy or to an incidental finding. If confirmed, it may have a therapeutic impact.

scholarly journals Multimodality therapy in subclassified stage IIIA–N2 non-small cell lung cancer patients according to the Robinson classification: heterogeneity and management

2018 ◽  
Vol 10 (6) ◽  
pp. 3585-3594 ◽  
Author(s):  
Hans-Stefan Hofmann ◽  
Jan Braess ◽  
Susanne Leipelt ◽  
Michael Allgäuer ◽  
Monika Klinkhammer-Schalke ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cancer Patients ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Multimodality Therapy ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Lung Cancer Patients

Size of Stage IIIA Primary Lung Cancers and Survival: A Surveillance, Epidemiology and End Results Database Analysis

2012 ◽  
Vol 78 (11) ◽  
pp. 1232-1237 ◽  
Author(s):  
Steven Maximus ◽  
Danh V. Nguyen ◽  
Yi Mu ◽  
Royce F. Calhoun ◽  
David T. Cooke
Keyword(s):  
Lung Cancer ◽  
Risk Factor ◽  
Tumor Size ◽  
Early Stage ◽  
Large Population ◽  
Nonsmall Cell Lung Cancer ◽  
Stage Iiia ◽  
Early Stage Lung Cancer ◽  
Iiia Nsclc ◽  
End Results

Size of early-stage lung cancer is important in the prognosis of patients. We examined the large population-based Surveillance, Epidemiology and End Results database to determine if tumor size was an independent risk factor of survival in patients undergoing lobectomy for N2 positive Stage IIIA nonsmall cell lung cancer (NSCLC). This study identified 1971 patients diagnosed with N2 positive Stage IIIA NSCLC, from 1998 to 2007, and who underwent lobectomy. Five tumor groups based on the seventh edition TNM lung cancer staging system (pathologic T1a 2 cm or less; T1b greater than 2 cm and 3 cm or less; T2a greater than 3 cm and 5 cm or less; T2b greater than 5 cm and 7 cm or less; T3 greater than 7 cm) were analyzed. Survival was reduced in patients with T3, T2a, and T2b tumors compared with patients with T1a and T1b ( P < 0.001). Survival estimates correlated with tumor size with poorer survival in T3 followed by T2b, T2a, and then T1b and T1a. Cohorts with T1a (hazard ratio [HR], 0.53; P = 0.01) and T1b (HR, 0.54; P = 0.01) were both found to have decreased hazard of death. Negative predictors of survival, in addition to increasing tumor size, included age and male gender, whereas positive predictors included tumor Grade I and upper lobe location. Increasing size of tumor is an independent negative risk factor for survival in patients undergoing lobectomy for N2 positive Stage IIIA NSCLC.

Prognostic value of CXLC 9 in patients undergoing neoadjuvant radiochemotherapy and surgery in stage IIIA NSCLC.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e24156-e24156
Author(s):  
Wolfgang Parsch ◽  
Ralph M Wirtz ◽  
Bettina Braunecker ◽  
Dieter Würflein ◽  
Clemens Albrecht ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Neoadjuvant Radiochemotherapy ◽  
Stage Iiia ◽  
Iiia Nsclc

scholarly journals Efficacy and Safety of Neoadjuvant Targeted Therapy vs. Neoadjuvant Chemotherapy for Stage IIIA EGFR-Mutant Non-small Cell Lung Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Dong Chen ◽  
Zixian Jin ◽  
Jian Zhang ◽  
Congcong Xu ◽  
Kanghao Zhu ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Randomized Controlled Trials ◽  
Egfr Mutation ◽  
Response Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Stage Iiia ◽  
Randomized Controlled ◽  
Grade 3 ◽  
Iiia Nsclc

Purpose: The role of targeted therapy in the neoadjuvant field of stage IIIA epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) is still controversial. We sought to evaluate the efficacy and safety of neoadjuvant targeted therapy (NTT) with neoadjuvant chemotherapy (NCT) used as a benchmark comparator.Methods: A systematic search was conducted in four databases (Pubmed, Cochrane Library, Embase, CNKI) for eligible studies on NTT published before October 2020. The primary endpoints were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and grade 3/4 adverse events (AEs). Statistical analysis and bias assessment were performed by RevMan 5.3.Results: A total of 319 patients, including 3 randomized controlled trials and 2 non-randomized controlled trials, were included in the meta-analysis. Perform the second subgroup analysis after excluding 2 non-randomized controlled trials. The meta-analysis reveals that, for EGFR mutation-positive stage IIIA NSCLC patients, compared with NCT, NTT can significantly increase ORR (relative risk [RR]:1.70, 95% confidence interval [CI]:1.35–2.15; subgroup-RR:1.56, 95% CI 1.23–2.0) and significantly reduce grade 3/4 AEs (RR:0.5, 95% CI 0.34–0.75; subgroup-RR: 0.53, 95% CI 0.26–1.08). The OS of the NTT arm is slightly higher, but the difference is not significant (hazards ratio [HR]: 0.74, 95% CI: 0.43–1.27; subgroup-HR: 0.64 95% CI 0.40–1.03). No difference in PFS was found (HR: 0.81, 95% CI 0.27–2.44).Conclusion: In neoadjuvant setting, targeted therapy has a definitive effect on patients with EGFR mutation-positive stage IIIA NSCLC and is even better than chemotherapy in terms of toxicity and tumor response rate.Systematic Review Registration: PROSPERO, identifier CRD42021221136.

Cost of combined modality interventions for stage III non-small-cell lung cancer.

1997 ◽  
Vol 15 (9) ◽  
pp. 3038-3048 ◽  
Author(s):  
W K Evans ◽  
B P Will ◽  
J M Berthelot ◽  
C C Earle
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Combined Modality Therapy ◽  
Cost Effective ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Combined Modality ◽  
Iiia Nsclc ◽  
The Cost

PURPOSE To evaluate the cost-effectiveness (CE) of new combined modality strategies in patients with stage III non-small-cell lung cancer (NSCLC). METHODS Recent studies suggest that combined modality therapy confers a survival advantage for patients with stage III NSCLC. Using the Statistics Canada (Ottawa, Canada) lung cancer costing model, we have evaluated the CE of these interventions using 1993 Canadian health care costs and the perspective of the government as payer in a universal health care system. RESULTS We estimate that the cost to treat a stage IIIa NSCLC patient with preoperative and postoperative chemotherapy would increase by $15,886, and a similar combined modality approach with the addition of postoperative radiotherapy would increase the cost by $22,963. Chemoradiotherapy for stage IIIb NSCLC would produce a smaller incremental cost of approximately $8,912 per case. However, these approaches are remarkably cost-effective, with cost per life-year gained (LYG) ranging from $3,348 to $14,958. Administering all chemotherapy in the outpatient department would improve CE. For sensitivity analysis, we reduced the survival gain that resulted from the three interventions by 25% and 50%, and increased the hospital per diem rates by 10%, 20%, and 30%. CONCLUSION Even with the most adverse assumptions, the CE estimates were all considered acceptable for new health care technologies in Canada. Overall, it appears that neoadjuvant therapy for stage IIIa NSCLC and combined modality therapy for stage IIIb NSCLC are cost-effective. Economic considerations should not be a barrier to their adoption.

Neoadjuvant weekly paclitaxel/cisplatin chemotherapy (WTP) with concurrent thoracic chemoradiation followed by surgical resection for stage IIIA (pN2) non-small cell lung cancer (NCLC): Phase II study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17036-17036 ◽  
Author(s):  
S. Kim ◽  
H. Sohn ◽  
C. Suh ◽  
J. Ryu ◽  
E. Choi ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Univariate Analysis ◽  
Whole Body ◽  
Stage Iiia ◽  
Term Survival ◽  
Weekly Chemotherapy ◽  
Long Term Survival ◽  
Thoracic Radiation ◽  
Iiia Nsclc

17036 Background: To investigate the role of weekly chemotherapy with paclitaxel/cisplatin and concurrent thoracic radiation (RT) as neoadjuvant therapy before surgical resection for patients with N2-IIIA NSCLC. Methods: Patients with pathologically proven N2 (pN2) and operable stage IIIA NSCLC were eligible. Six weekly chemotherapy with paclitaxel (50 mg/m2)/cisplatin (20 mg/m2) was given with concurrent thoracic RT (1.8 Gy/fraction once a day, 45 Gy) during 5 weeks. Chest CT, whole body PET were checked before and 3 weeks after chemoradiation. For the patients without clearing pN2 nodes or with pT3 after surgical resection, boost RT (20 Gy) was given. Results: From Jan. 2002 to Nov. 2005, 38 patients were enrolled. Median follow-up time was 20 months: gender (male: female, 30:8,), age (median 56, 42–67). Of them, 31 patients underwent surgical resection. Three patients showed brain metastasis during chmoradiation. Two patients refused surgical resection after chemoradiation. One patient showed severe radiation pneumonitis and was not fit for the operation. One patient showed lung to lung metastases before surgical resection. Of the 31 patients who underwent surgical resection, 14 (45.2%) showed pN0–1, and 7 (22.6%) showed pathologic complete remission (CR). Three year overall survival rate of all patients was 37.7% (median 35.9 months) and 3 year progression free survival was 34.2% (median 18 months). In univariate analysis, clearing N2 node and pathologic CR after surgery were the factors that could predict long-term survival. And the 2nd PET after chemoradiaiton could not expect clearing N2 nodes after surgical resection: sensitivity 44%, specificity 46%. As toxicities of WTP, hypersensivity reaction to paclitaxel and pneumonia with neutropenia were noted in 1 patient each. Severe radiation pneumonits was noted in 4 (of them 3 were given 65 Gy). Conclusions: WTP followed by surgical resection for N2-stage IIIA NSCLC was feasible. Clearing N2 nodes or pathologic CR after surgical resection were the factors of long-term survival. The usefulness of 2nd PET to expect the clearing N2 nodes was not adequate. No significant financial relationships to disclose.

Low nationwide utilization of adjuvant chemotherapy (AC) in elderly patients with localized non-small cell lung cancer (NSCLC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6581-6581
Author(s):  
Kaushal Parikh ◽  
Urshila Durani ◽  
Jonathan Inselman ◽  
Shealeigh Funni ◽  
Gaurav Goyal ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Private Insurance ◽  
Age Groups ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Stage Iiia ◽  
Academic Center ◽  
Comorbidity Index ◽  
Iiia Nsclc ◽  
Use Factors

6581 Background: While AC is recommended for all patients with stage IIA, IIB, and IIIA NSCLC, its use and benefit among the elderly population is unclear. Methods: We identified patients with stage IIA, IIB, or IIIA NSCLC using the National Cancer Database from 2006-2014. Patients were divided into age groups ≤65, 66-70, 71-75, 76-80, > 80 years. Trends in AC use, factors influencing AC administration, and outcomes associated with AC were studied. Results: Out of 27368 patients, 13464 received AC and 13904 did not. 11% had stage IIA disease, 50% had stage IIB disease and 39% had stage IIIA disease. AC use was lower with increasing age (49% age ≤65 vs. 3% age > 80 (P < 0.0001)). Temporal use of chemotherapy for each age group was unchanged from 2006-2014. In multivariate logistic regression analysis, factors predictive of lower AC use were older age, Medicare or Medicaid insurance, academic center, and higher Charlson Comorbidity Index (CCI). Stage IIIA (OR 1.4, 95% CI 1.3-1.6) and Stage IIB (OR 1.3, 95% CI 1.2-1.4) had a higher chance of receiving AC than stage IIA. In a Cox proportional hazard model, younger age, female sex, academic center, private insurance, higher income, lower CCI, West coast center and AC were associated with better outcomes. When stratified by age and stage, AC was still associated with better survival (Table). Conclusions: AC utilization in stages IIA, IIB and IIIA NSCLC remains low, despite its association with improved survival in the elderly. Future clinical trials may be needed focused on elderly patients to establish the best regimen to optimize outcomes. [Table: see text]

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