Neoadjuvant Therapy and Factors Influencing Survival in Locally Advanced Non-Small Cell Lung Cancer

Senar Ebinç; Zeynep Oruç; Ziya Kalkan; Fatma Teke; Serdar Onat; Zuhat Urakçı; Muhammet Ali Kaplan; Mehmet Küçüköner; Abdurrahman Işıkdoğan

doi:10.7759/cureus.33392

Neoadjuvant Therapy and Factors Influencing Survival in Locally Advanced Non-Small Cell Lung Cancer

Cureus. 2023 Jan 5;15(1):e33392. doi: 10.7759/cureus.33392. eCollection 2023 Jan.

Authors

Senar Ebinç¹, Zeynep Oruç², Ziya Kalkan², Fatma Teke³, Serdar Onat⁴, Zuhat Urakçı², Muhammet Ali Kaplan², Mehmet Küçüköner², Abdurrahman Işıkdoğan²

Affiliations

¹ Department of Medical Oncology, Gazi Yasargil Training and Research Hospital, Diyarbakır, TUR.
² Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakır, TUR.
³ Department of Radiation Oncology, Dicle University Faculty of Medicine, Diyarbakır, TUR.
⁴ Department of Thoracic Surgery, Dicle University Faculty of Medicine, Diyarbakır, TUR.

Abstract

Aim: We aimed to investigate the effectiveness of neoadjuvant therapy (NAT) and clinicopathological characteristics in locally advanced non-small cell lung cancer (NSCLC) (IIIA-IIIB), as well as the influence of the post-NAT treatment modalities on survival.

Materials and methods: This study included patients who presented to the Dicle University Medical Oncology Clinic and received NAT for a diagnosis of locally advanced NSCLC between 2004 and 2020. Clinicopathological and radiological data of the 57 patients whose data could be retrieved from the hospital archive system were retrospectively reviewed. Patients' overall survival (OS) and failure-free survival (FFS) times and the factors influencing these times were evaluated.

Results: This study included a total of 57 patients consisting of five (8.8%) females and 52 (91.2%) males. The median patient age at diagnosis was 58 (30-75) years. All patients had received four courses of chemotherapy during the neoadjuvant period. When the factors influencing OS were evaluated, the post-NAT modality was found to have a statistically significant effect on survival. FFS times were 12, 13, and 16 months in the chemotherapy, chemoradiotherapy, and surgery arms, respectively (log-rank p=0.035). FFS was longer in those who underwent surgery (Hazard ratio (HR): 0.33, 95 % CI: 0.14-0.77, (p=0.01)). OS times were 20, 21, and 55 months in the chemotherapy, chemoradiotherapy, and surgery arms, respectively (log-rank p=0.05). OS was longer in the arm undergoing surgery compared to the other arms (HR: 0.36, 95% CI: 0.14-0.87, (p=0.02)). Five-year survival rates for the chemotherapy, chemoradiotherapy, and surgery arms were 14.3%, 21.4%, and 40%, respectively.

Conclusions: This study shows that achieving an operable status is the most important indicator of survival and that patients undergoing surgery have a marked advantage in OS and FFS compared with patients receiving chemoradiotherapy or palliative chemotherapy.

Keywords: chemoradiotherapy; lung cancer; multimodal treatment; neoadjuvant chemotherapy; surgery.