LONG-TERM CRITERIA EFFECTIVENESS OF MULTIMODAL TREATMENT OF PATIENTS WITH STADIA IIIA (N2) NON-SMALL CELL LUNG CANCER
DOI:
https://doi.org/10.15407/oncology.2025.02.139Keywords:
non-small cellr lung cancer IIIA (N2), neoadjuvant chemoradiotherapy, neoadjuvant chemotherapy, long-term overall and recurrence free survivalAbstract
Summary. Stage IIIA (N2) non-small cell lung cancer (NSCLC) is a heterogeneous disease with controversial treatment options and a poor prognosis. The optimal treatment strategy for stage IIIA (N2) NSCLC remains controversial, and no definitive treatment has been established. Aim: to analyze the 5-year the overall survival and survival without relapse of patients with stage IIIA (N2) NSCLC after the use of different multimodality treatment regimens. Object and methods: Comparative studies of different neoadjuvant and adjuvant treatment regimens using radiotherapy (RT) and chemotherapy (CT) in the case of surgical intervention in stage IIIA (N2) NSCLC were conducted. The studies were performed in the Department of Lung and Mediastinal Tumors of the National Cancer Institute. The effect of neoadjuvant chemoradiotherapy (NCRT) was studied in 43 patients, neoadjuvant chemotherapy (NCT) in 200, and NCT with subsequent surgery and RT in the adjuvant regimen in 63 patients. In all groups, NCT included 4 cycles of CT according to the cisplatin + docetaxel or carboplatin + paclitaxel regimens. RT was performed in daily sessions with a single dose of 2 Gy and SOD up to 50 Gy, followed by radical surgery. Survival rates of patients were analyzed by the Kaplan-Meier method (log-rank test). Results: from the 12-month period to the end of the study, the best relapse-free survival was recorded in the NCRT group. Patients with complete and high-grade morphological tumor response had a significantly longer survival period than other patients in their group. The highest number of complete morphological tumor responses (CMR) was found in the NCRT group. Performing NCRT reduced the number of pneumonectomies in favor of organ-sparing resections. The overall five-year survival rate after performing NCRT was 30.1 ± 5.7%, NCT — 12.3 ± 3.5%, NCT with adjuvant RT — 6.3 ± 2.2%. Conclusions: long-term survival of patients with stage IIIA(N2) NSCLC demonstrated the superiority of neoadjuvant chemoradiotherapy over other neoadjuvant and adjuvant treatment methods. The five-year recurrence-free survival was observed only in the NCRT group and was 21.5 ± 6.4%.
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