“Unfortunately the study was unable to meet its accrual goal,” wrote Dr. Masters. “It is still possible that 1 of the 2 treatment strategies is superior and we have not been able to identify that due to the small study size.”
The authors noted that they were unable to rule out stage migration related to patient selection in their trial, but also wrote that the 5-year overall survival rate data from this trial “are among the best reported so far from prospective trials with definitive chemoradiotherapy.”
They concluded from their results that both surgery and a chemoradiotherapy boost “lead to excellent long-term overall survival and progression-free survival,” and that both treatments “remain valuable options for patients with stage 3 disease for whom surgery is potentially considered.”
“I suspect that this study will not have a dramatic impact on clinical practice because both management options…show good outcomes,” wrote Dr. Masters.
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“I would caution that this study probably applies only to the best candidates for therapy. There remains a large group of patients with more comorbidities or worse overall functional status who may not be eligible for surgery and for those patients combined chemotherapy and radiation remains the standard of care.”
“There is not definitive evidence that surgical resection following chemotherapy and radiation will absolutely lead to improved overall survival,” concluded Dr. Masters. “Nonetheless this study does help us in our discussion with patients to define the available treatment options, risks, and potential outcomes with the various strategies.”
- Eberhardt W, Pӧttgen C, Gauler TC, et al. 2015. Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA (N2) and selected IIIB non–small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE) [published online ahead of print November 2, 2015]. J Clin Oncol. doi: 10.1200/JCO.2015.62.6812.