A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIa non-small-cell lung cancer

Noël, G.; Mazeron, J. J.

doi:10.1016/s1278-3218(00)00066-4

Cited by 44 publications

(52 citation statements)

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“…This outcome was consistent with the results of a randomized trial initiated by the Eastern Cooperative Oncology Group. 27 A meta-analysis reported that PORT was detrimental to pN0-1 patients. 28 The use of chemotherapy alone rather than chemoradiotherapy is preferred by some oncologists, but PORT is feasible if not administered prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of adjuvant therapy in T4 non‐small cell lung cancer: An inverse probability of treatment weighting analysis

Song

Yang

et al. 2019

Thoracic Cancer

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Background According to the current clinical guidelines, chemoradiotherapy is considered the standard treatment for locally advanced non‐small cell lung cancer (NSCLC). We analyzed the prognostic effect of adjuvant chemotherapy (ACT) in resected patients using the new eighth tumor node metastasis (TNM) staging systems based on the Surveillance, Epidemiology and End Results database. Methods We identified 3008 patients with stage IIIA NSCLC (T4N0M0) who underwent sublobar resection, lobectomy, or pneumonectomy. Covariates affecting treatment selection or survival were included as part of propensity score models for matching and weighting. The effect of ACT on survival was assessed, stratified by postoperative radiation therapy (PORT) use, tumor size, and age. Results Analyses of 2016 patients were conducted with standardized differences in covariates < 10% after matching. ACT was associated with significantly improved five‐year overall survival (51.1% vs. 39.7%; P = 0.0260) in patients aged 21–65 with > 7 cm tumors, even after adjusting for the presence or absence of the superior sulcus ( P = 0.0003). No significant outcomes were observed using other stratifications in the matched analysis. Moreover, ACT with PORT conferred a potential survival benefit in 21–65‐year‐old patients with 0–7 cm tumors (for all causes of death: hazard ratio 0.414, 95% confidence interval 0.251–0.684). Conclusion In this population‐based cohort, ACT prolonged the survival of patients aged 21–65 with a tumor > 7 cm, with or without PORT. Inverse probability of treatment weighting can estimate the treatment effect and is suitable for use with survival data.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of adjuvant therapy in T4 non‐small cell lung cancer: An inverse probability of treatment weighting analysis

Song

Yang

et al. 2019

Thoracic Cancer

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“…Before the publication of the PORT overview, PORT was considered the standard treatment by many clinicians for stage II and stage III patients; thus, the Eastern Cooperative Oncology Group (ECOG) completed a prospective trial comparing PORT, at a dose of 50.4 Gy in 1.80-Gy fractions, with PORT plus concomitant chemotherapy combining etoposide and cisplatin [31]. The 3-year survival rates were 52% in the PORT arm and 50% in the combined treatment arm (p ϭ .56).…”

Section: Adjuvant Chemoradiotherapy In Stage II and Iii Patientsmentioning

confidence: 99%

Role of Postoperative Radiotherapy in Resected Non-Small Cell Lung Cancer: A Reassessment Based on New Data

Péchoux

2011

The Oncologist

117

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After completing this course, the reader will be able to: 1. Identify patients with non-small cell lung cancer who may benefit from postoperative radiotherapy based upon current evidence. 2. Summarize the results of analyses of both older and more recent data regarding postoperative radiotherapy in NSCLC patients. ABSTRACT In completely resected non-small cell lung cancer (NSCLC) patients with pathologically involved mediasti-nal lymph nodes (N2), administration of adjuvant platinum based chemotherapy is now considered the standard of care, based on level 1 evidence. The role of postoperative radiation therapy (PORT) in this group of patients remains controversial. The PORT meta-analysis published in 1998 concluded that adjuvant radiotherapy was detrimental to patients with early-stage completely resected NSCLC, but that the role of PORT in the treatment of tumors with N2 involvement was unclear, and that further research was warranted. Recent retrospective and non-randomized studies, as well as subgroup analyses of recent randomized trials evaluating adjuvant chemotherapy, provide evidence of the possible benefit of PORT in patients with mediastinal nodal involvement. The role of PORT is also a valid question in patients with proven N2 disease who have undergone only induction chemotherapy followed by surgery, because the local recurrence rate for such patients varies in the range of 20%-60%. Based on the currently available data, PORT should be discussed for fit patients with completely resected NSCLC with N2 nodal involvement, preferably after completion of adju-vant chemotherapy. There is a need for new randomized evidence to evaluate PORT using the modern three-dimensional conformal radiation technique, with attention paid to reducing the risk for, particularly, pulmonary and cardiac toxicity. A new large multi-institutional randomized trial evaluating PORT in this patient population is needed and now under way. The Oncologist 2011;16:672-681

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“…Recent evidence suggests that chemotherapy administered after surgery results in significantly better overall survival and disease-free survival rates [58,59]. These recent results with cisplatin and uracil and tegafur (UFT) chemotherapy contradict prior data that showed no survival benefit with adjuvant chemotherapy [58][59][60]. It has been proposed that TK inhibitors may improve adjuvant treatment for stage I NSCLC and lead to improved overall survival.…”

Section: Potential For Tk-targeted Therapies Across Tumor Types and Smentioning

confidence: 99%

Activation of Tyrosine Kinases in Cancer

2003

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A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIa non-small-cell lung cancer

Cited by 44 publications

References 2 publications

Prognostic value of adjuvant therapy in T4 non‐small cell lung cancer: An inverse probability of treatment weighting analysis

Prognostic value of adjuvant therapy in T4 non‐small cell lung cancer: An inverse probability of treatment weighting analysis

Role of Postoperative Radiotherapy in Resected Non-Small Cell Lung Cancer: A Reassessment Based on New Data

Activation of Tyrosine Kinases in Cancer

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