Clinical outcomes with perioperative chemotherapy in sarcomatoid carcinomas of the lung.

Abstract

INTRODUCTION:

In patients with resected lung cancer, sarcomatoid carcinomas are reputed to carry a worse prognosis. Although generally felt to be chemo-refractory, little data are available about chemotherapy in these patients. We sought to determine the effect of perioperative chemotherapy in patients with completely resected sarcomatoid carcinomas of the lung.

METHODS:

We reviewed the pathology reports of 4675 patients consecutively resected at Memorial Sloan-Kettering between 2000 and 2010. Charts and images were reviewed for patients with a histologic diagnosis of sarcomatoid carcinoma. Response to neoadjuvant chemotherapy was assessed radiographically. Kaplan-Meier disease-free probability (DFP) curves were compared for patients who did and did not receive perioperative chemotherapy, stratified by pathological stage.

RESULTS:

Of the 4675 patients who underwent an R0 lung cancer resection, 56 (1%) were diagnosed with sarcomatoid carcinomas. Twenty received neoadjuvant and/or adjuvant chemotherapy. Overall radiographic response rate (minor + major) to neoadjuvant chemotherapy was 73% (95% confidence interval 48-90%) in the 15 evaluable patients. The median DFP of patients who received chemotherapy was 34 months versus 12 months in those who did not (p = 0.37). Subset analysis did not reveal a benefit to perioperative chemotherapy in patients with stage Ib-IIa, whereas a benefit was seen in patients with IIb-IIIa disease (p = 0.02).

CONCLUSIONS:

Although sarcomatoid carcinomas are felt to be chemo-refractory, our results demonstrate radiographic responses to neoadjuvant chemotherapy and an improvement in DFP in patients with stage IIb-IIIa disease. The use of pathological stage in this analysis may underestimate this benefit. Perioperative chemotherapy should be considered in these patients.

• Authors: Jamie E Chaft, Camelia S Sima, Michelle S Ginsberg, James Huang, Mark G Kris, William D Travis, Christopher G Azzoli
• Journal: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer (J Thorac Oncol) Vol. 7 Issue 9 Pg. 1400-5 (Sep 2012) ISSN: 1556-1380 [Electronic] United States
• PMID: 22895138 (Publication Type: Journal Article)

Topics

• Adenocarcinoma (drug therapy, mortality, secondary)
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carcinoma, Large Cell (drug therapy, mortality, secondary)
• Carcinoma, Non-Small-Cell Lung (drug therapy, mortality, secondary)
• Carcinoma, Squamous Cell (drug therapy, mortality, secondary)
• Carcinosarcoma (drug therapy, mortality, secondary)
• Chemotherapy, Adjuvant
• Female
• Follow-Up Studies
• Humans
• Lung Neoplasms (drug therapy, mortality, pathology)
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Staging
• Prognosis
• Survival Rate