Evaluation of Failure Patterns Using Trimodality in Non-Small Cell Lung Cancer.

Background: The effectiveness of trimodality therapy in NSCLC has been controversial.

Methods: Ninety-two patients with stage III NSCLC were analyzed retrospectively based on treatment given. Overall survival (OS) and patterns of failure were examined in patients treated with chemoradiation alone (Group 1) versus neoadjuvant chemoradiation followed by surgical resection (Group 2).

Results: OS for 2, 3, and 5 years in Group 1 and 2 were 19.7%, 15.7%, and 4.5% versus 56.4%, 40.4%, and 32.3% (P = 0.003), respectively. Median survival for Group 1 and 2 was 11.0 and 34.0 months, respectively (P = 0.003). The recurrence rate in Group 1 was 61.8% (47 of 76) with distant non-brain involvement (48.9%). In Group 2 it was 50.0% (8 of 16) with brain (50%) involvement.

Conclusions: Patients with stage IIIA and, perhaps IIIB NSCLC with a high performance status should be considered for trimodality treatment.