The efficacy and safety of induction chemoradiotherapy (ICRT) followed by surgery in stage III NSCLC patients (pts) with T3/4-adjacent organ invasion involved(AOI): A single-center retrospective observational study.

Background: The 2-year overall survival (OS) of c-Stage IIIA/B non-small cell lung cancer (NSCLC) is each 53% and 34% in IASLC Staging Project (7th) and the treatments remain controversial. Especially, multimodal treatment at stage III (T3/4-AOI) is poorly studied. Method: This retrospective observational study aimed to elucidate the efficacy and safety of tri-modality therapy in pts with stage III NSCLC (T3/4-AOI). We included all pts who received ICRT (2 cycles of DOC/CDDP or PAC/CBDCA plus 40–46 Gy of thoracic radiation) between 2014 and 2017 at our institution. Results: 35 pts (mean age, 66y) with stage III NSCLC (T3/4-AOI, any-N proven by EBUS-TBNA) judged as pre-ICRT resectable by a multidisciplinary tumor board, were enrolled. There were 21 T3 and 14 T4 cases; and 17 adenocarcinoma, 17 squamous cell carcinoma, and 1 not-otherwise-specified case. One pneumonectomy and 28 lobectomies; and 11 tracheobronchial, 6 chest wall, 7 great vessel, and 6 cardiac resections were performed. 26 pts (90%) achieved R0 resection. 6 pts did not undergo surgery due to disease progression (n=3), performance status decline (n=1), and severe radiation pneumonitis (n=2). No pts died during ICRT or within 6 months post-surgery. The 2-year OS and recurrence-free survival (RFS) rate in those who completed the 2-year follow-up was each 74% (17/23) and 68% (15/22), respectively. In total, each 12 and 13 pts have not reached 2-year follow-up yet. Conclusion: Surgery after ICRT in pts with stage III NSCLC (T3/4-AOI) was well tolerated and potentially benefitted survival.