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BACKGROUND: IIIA non-small-cell lung cancer (NSCLC) is associated with low survival following surgery. This study reports a meta-analysis of randomized trials (RCTs) comparing surgery alone (S) with neoadjuvant chemotherapy plus surgery (CS) to determine effectiveness of chemotherapy in improving survival for stage IIIA NSCLC.
METHODS: We searched Medline and resulting bibliographies to identify RCTs comparing CS with S for resectable stage IIIA NSCLC. We then used a prospectively designed form to abstract demographics, treatment type/schedule, resection rate, cancer recurrence, operative mortality, and survival. Random effects ANOVA allowed comparison of survival between groups.
RESULTS: We identified 8 RCTs including 663 patients. One, two, and three year survival rates were greater in the CS group than in the S group (CS = 67, S = 46.1, p = 0.03; CS = 42.5, S = 24.3, p = 0.04; CS = 32, S = 13.8, p = 0.04, respectively). Survival was similar after 5 years (p = 0.44). The groups did not differ in rate of complete resection, overall resection rate, local recurrence, distant recurrence, all recurrence, preoperative mortality, operative mortality, or all mortality (p = ns for all).
CONCLUSIONS: Neoadjuvant chemotherapy for IIIA NSCLC improved survival in the first 3 years, but not at 5 years, compared to surgery alone. Surgery-alone patients had more cancer recurrences and all cause mortality, but these differences were not significant. If future work supports the trend of improved short term survival, it will also be important to determine the impact of chemotherapy on quality of life.