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Current Oncology
Volume 26
Issue 3
10.3747/co.26.4549
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Review

Surgery after Chemoradiotherapy in Patients with Stage III (n2 or N3, Excluding T4) Non-Small-Cell Lung Cancer: A Systematic Review

by
A. Swaminath
1,*,
E. T. Vella
2,
K. Ramchandar
3,
A. Robinson
4,
C. Simone
5,
A. Sun
6,
Y. C. Ung
7,
K. Yasufuku
8 and
P. M. Ellis
9
1
Radiation Oncology, Juravinski Cancer Centre, and Department of Oncology, McMaster University, Hamilton, ON, Canada
2
Program in Evidence-Based Care, McMaster University, Hamilton, ON, Canada
3
Radiation Oncology, Thunder Bay Regional Health Sciences Centre–Cancer Care, Thunder Bay, ON, Canada
4
Medical Oncology, Kingston General Hospital, Kingston, ON, Canada
5
Department of Surgery, Michael Garron Hospital, Toronto, ON, Canada
6
Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
7
Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
8
Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada
9
Medical Oncology, Juravinski Cancer Centre, and Department of Oncology, McMaster University, Hamilton, ON, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2019, 26(3), 398-404; https://doi.org/10.3747/co.26.4549
Submission received: 12 March 2019 / Revised: 10 April 2019 / Accepted: 5 May 2019 / Published: 1 June 2019

Abstract

Background: Chemoradiation with curative intent is considered the standard of care in patients with locally advanced, stage III non-small-cell lung cancer (NSCLC). However, some patients with stage III (N2 or N3, excluding T4) NSCLC might be eligible for surgery. The objective of the present systematic review was to investigate the efficacy of surgery after chemoradiotherapy compared with chemoradiotherapy alone in patients with potentially resectable locally advanced NSCLC. Methods: A search of the MEDLINE, EMBASE, and PubMed databases sought randomized controlled trials (RCTS) comparing surgery after chemoradiotherapy with chemoradiotherapy alone in patients with stage III (N2 or N3, excluding T4) NSCLC. Results: Three included RCTS consistently found no statistically significant difference in overall survival between patients with locally advanced NSCLC who received surgery and chemoradiotherapy or chemoradiotherapy alone. Only one rct found that progression-free survival was significantly longer in patients treated with chemoradiation and surgery (hazard ratio: 0.77; 95% confidence interval: 0.62 to 0.96). In a post hoc analysis of the same trial, the overall survival rate was higher in the surgical group than in matched patients in a chemoradiation-only group if a lobectomy was performed (p = 0.002), but not if a pneumonectomy was performed. Furthermore, fewer treatment-related deaths occurred in patients who underwent lobectomy than in those who underwent pneumonectomy. Conclusions: For patients with locally advanced NSCLC, the benefits of surgery after chemoradiation are uncertain. Surgery after chemoradiation for patients who do not require a pneumonectomy might be an option.
Keywords: non-small-cell lung cancer; locally advanced; chemotherapy; radiation therapy; lobectomy; pneumonectomy non-small-cell lung cancer; locally advanced; chemotherapy; radiation therapy; lobectomy; pneumonectomy

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MDPI and ACS Style

Swaminath, A.; Vella, E.T.; Ramchandar, K.; Robinson, A.; Simone, C.; Sun, A.; Ung, Y.C.; Yasufuku, K.; Ellis, P.M. Surgery after Chemoradiotherapy in Patients with Stage III (n2 or N3, Excluding T4) Non-Small-Cell Lung Cancer: A Systematic Review. Curr. Oncol. 2019, 26, 398-404. https://doi.org/10.3747/co.26.4549

AMA Style

Swaminath A, Vella ET, Ramchandar K, Robinson A, Simone C, Sun A, Ung YC, Yasufuku K, Ellis PM. Surgery after Chemoradiotherapy in Patients with Stage III (n2 or N3, Excluding T4) Non-Small-Cell Lung Cancer: A Systematic Review. Current Oncology. 2019; 26(3):398-404. https://doi.org/10.3747/co.26.4549

Chicago/Turabian Style

Swaminath, A., E. T. Vella, K. Ramchandar, A. Robinson, C. Simone, A. Sun, Y. C. Ung, K. Yasufuku, and P. M. Ellis. 2019. "Surgery after Chemoradiotherapy in Patients with Stage III (n2 or N3, Excluding T4) Non-Small-Cell Lung Cancer: A Systematic Review" Current Oncology 26, no. 3: 398-404. https://doi.org/10.3747/co.26.4549

APA Style

Swaminath, A., Vella, E. T., Ramchandar, K., Robinson, A., Simone, C., Sun, A., Ung, Y. C., Yasufuku, K., & Ellis, P. M. (2019). Surgery after Chemoradiotherapy in Patients with Stage III (n2 or N3, Excluding T4) Non-Small-Cell Lung Cancer: A Systematic Review. Current Oncology, 26(3), 398-404. https://doi.org/10.3747/co.26.4549

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