马上注册，阅读更多内容，享用更多功能！
您需要 登录 才可以下载或查看，没有账号？立即注册 
×
Albain K, et al. Radiotherapy plus chemo- therapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomized controlled trial. Lancet. 2009;374:379–86.
The Intergroup 0139 trial sought to evaluate whether the addition of surgical resection to concur- rent chemoradiotherapy improved survival in patients with pathologically documented N2 ade- nopathy (stage IIIA) non-small cell lung cancer. The chemotherapy consisted of cisplatin and etopo- side. The radiation therapy in patients randomized to surgery was to a dose of 45 Gy while in patients randomized to no surgery was to 61 Gy in standard size fractions.
If patients had suspicious N3 nodes on imaging, they were required to have a biopsy to exclude N3 disease. Patients met with specialists from surgery, medical oncology, and radiation oncology prior to enrollment in the trial to ensure that N2 adenopathy was present and that the cancer was technically resectable. The primary endpoint was overall survival. The study enrolled 429 patients between 1994 and 2001 (Fig. 3.3).
Key Point There was no significant difference in overall survival between the two arms of the trial although there was an improvement in progression-free survival in favor of patients randomized to preoperative chemoradiotherapy followed by surgery (Fig. 3.4).
The median overall survival was 23.6 months for surgery and 22.2 months for no surgery (HR 0.87, 95% CI 0.70 to 1.10, P = 0.24).
Progression-free survival at 5 years was 21% versus 11% in favor of the surgery group (P = 0.008). Median progression-free survival was 12.8 months versus 10.5 months in favor of the surgery group (HR = 0.77, 95% CI 0.62–0.96, P = 0.017).
More patients died without progression of disease in the surgery arm of the trial (18% versus 10%, P = 0.02).
Median survival for patients with pathologic N0 disease at the time of surgery following neoadjuvant chemoradiation therapy was 34.4 months. Median survival for patients with pathologic N1-3 or unknown nodal stage was 26.4 months.
There were no treatment-related deaths during the induction chemoradiotherapy. Subsequently, 16 patients (8%) died from non-cancer causes in the surgery arm of the trial and 14 of 16 of those patients died following pneumonectomy (Fig. 3.5).
This landmark intergroup trial did not demonstrate an overall survival improvement between study arms but did show that patients who went on to have surgery following induction chemoradiotherapy experienced a significant improvement in median progression-free survival. The study investigators performed an exploratory matching analysis that led investigators to hypothesize that such trimodality therapy with induction chemoradiation followed by surgery may benefit patients if surgery can be a lobectomy or if mortality from pneumonectomy can be avoided. Albain et al. reported that 45% of pathologic T0N0 specimens were resected with pneumonectomy, suggesting that pneumonectomy could have been avoided in some patients. Albain et al. stated, “this exploratory analysis could be useful in decision making to ensure caution when
a trimodality prescription with pneumonectomy
is considered.”
Fig. 3.3 Intergroup 0139 trial profile. (From Albain et al. Lancet 374: 379–86, 2009 with permission)
Fig. 3.4 (a) Progression-free survival and (b) overall survival in Intergroup 0139 trial. (From Albain et al. Lancet 374: 379–86, 2009 with permission)
Fig. 3.5 Overall survival on Intergroup 0139 for patients who underwent (a) lobectomy or (b) pneumonectomy versus a matched cohort of patients randomized to definitive chemoradiation without surgery. (From Albain et al. Lancet 374: 379–86, 2009 with permission)
|
|
