Sublobar Resection vs Lobectomy for High-Risk Stage I Non–Small Cell Lung Carcinoma

The Cancer and Leukemia Group B (CALGB140503; also known as ALLIANCE) is a phase 3 trial that demonstrated that peripheral (outer third of lung) non–small cell lung carcinoma (NSCLC) with tumor size 2 cm or smaller and lymph node (LN) negative for metastasis, sublobar resection (defined as wedge resection or segmentectomy) compared to lobectomy was not inferior in disease-free survival (DFS) and overall survival (OS). The Japan Clinical Oncology Group (JCOG0802; also known as West Japan Oncology Group WJOG4607L study) is also a phase 3 trial that revealed that peripheral NSCLC with tumor size 2 cm or smaller with consolidation to tumor ratio more than 0.5 and LN negative for metastasis, segmentectomy (wedge resection was not allowed) compared to lobectomy was not inferior in relapse-free survival (RFS) and OS. Both trials are practice changing and challenged the prior standard of care of lobectomy for peripheral tumors 3 cm and smaller and LN negative for metastasis as established by the Lung Cancer Study Group.

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Settembre 2024

Chemotherapy, Radiation Therapy, and Nasopharyngeal Carcinoma—Reply

In Reply We appreciate the comments made by Lee et al and Bayatfard et al on our recent article. We applied concurrent cisplatin in the conventional 30-mg/m2 dose weekly when we designed this trial. This dose was routinely used in the treatment of head and neck neoplasms, including nasopharyngeal carcinoma. A secondary analysis of a prospective trial revealed that a cumulative cisplatin dose of 200 mg/m2 is sufficient for patients with locoregionally advanced nasopharyngeal carcinoma who undergo concurrent chemoradiotherapy. Prospective evidence on the optimal concurrent cisplatin dose after induction chemotherapy is lacking. Results from a large-sample retrospective study showed that cumulative cisplatin doses between 100 mg/m2 and 200 mg/m2 achieved satisfactory outcomes. In our study, the median cumulative cisplatin dose during radiation therapy was 180 mg/m2. Therefore, we consider that for patients with locoregionally advanced nasopharyngeal carcinoma who receive induction chemotherapy, the doses of concurrent cisplatin do not influence therapeutic effects.

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Settembre 2024