• Aalok P Patel, Traves D Crabtree, Jennifer M Bell, Tracey J Guthrie, Clifford G Robinson, Daniel Morgensztern, Graham A Colditz, Daniel Kreisel, A Sasha Krupnick, Jeffrey D Bradley, G Alexander Patterson, Bryan F Meyers, and Varun Puri.
• *Department of Surgery, Division of Cardiothoracic Surgery; †Department of Radiation Oncology; and ‡Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO.
• J Thorac Oncol. 2014 May 1; 9 (5): 612-21.

IntroductionThe role of surgery in addition to chemotherapy and radiation for stage IIIA non-small-cell lung cancer (NSCLC) remains controversial. Because there are limited data on the benefit from surgery in this setting, we evaluated the use of combined modality therapy nationally and explored the outcomes with and without the addition of surgery.MethodsPatient variables and treatment-related outcomes were abstracted for patients with clinical stage IIIA NSCLC from the National Cancer Database. Patients receiving chemotherapy and radiation were compared with those undergoing chemotherapy, radiation, and surgery (CRS) in any sequence.ResultsBetween 1998 and 2010, 61,339 patients underwent combined modality treatment for clinical stage IIIA NSCLC. Of these, 51,979 (84.7%) received chemotherapy and radiation while 9360 (15.3%) underwent CRS. Patients in the CRS group were younger, more likely female patients and Caucasians, and had smaller tumors and lower Charlson comorbidity scores. The 30-day surgical mortality was 200 of 8993 (2.2%). The median overall survival favored the CRS group in both unmatched (32.4 months versus 15.7 months, p < 0.001) and matched analysis based on patient characteristics (34.3 versus 18.4 months, p < 0.001).ConclusionsThere is significant heterogeneity in the treatment of stage IIIA NSCLC in the United States. Patients selected for surgery in addition to chemoradiation therapy seem to have better long-term survival.

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