Adjuvant chemotherapy plus radiotherapy is superior to chemotherapy following surgical treatment of stage IIIA N2 non-small-cell lung cancer

Abstract

The use of additional radiotherapy for resected stage IIIA N2 non-small-cell lung cancer in the setting of standard adjuvant chemotherapy remains controversial. A comprehensive search (last search updated in March 2015) for relevant studies comparing patients with stage IIIA N2 non-small-cell lung cancer undergoing resection after treatment with adjuvant postoperative chemotherapy alone or adjuvant postoperative chemoradiotherapy (POCRT) was conducted. Hazard ratios (HRs) were extracted from these studies to give pooled estimates of the effects of POCRT on overall survival (OS) and disease-free survival (DFS). Six studies were included. The meta-analysis demonstrated that POCRT had a greater OS benefit than postoperative chemotherapy (HR =0.87, 95% confidence interval [CI]: 0.79–0.96, P=0.006). Unfortunately, there was no significant difference in DFS between the two groups: the combined HR for DFS was 0.91 (95% CI: 0.57–1.46, P=0.706). In a subgroup analysis of two randomized controlled trials (n=172 patients), adding radiation was of no benefit to either OS (HR =0.72, 95% CI: 0.49–1.06, P=0.094) or DFS (HR =1.45, 95% CI: 1.00–2.09, P=0.047). In summary, compared with postoperative chemotherapy, POCRT was beneficial to OS but not DFS in patients with stage IIIA N2 non-small-cell lung cancer.

Evaluation of Postoperative Radiotherapy Effect on Survival of Resected Stage III-N2 Non-small Cell Lung Cancer Patients

“…Mikell et al ( 18 ) analyzed 2,115 patients with NSCLC in N2 stage who received POCT from 2004 to 2006 in NCDB database, and they concluded that compared with the control group, PORT can improve the 5-years survival rate (39.8 vs. 34.7%, P = 0.048). Lei et al ( 19 ) showed that compared with POCT, PORT combined with POCT was beneficial to OS of IIIA-N2 NSCLC patients, but not to DFS. Our results revealed that for patients with <6 lymph node metastases, PORT combined with POCT therapy has no significant benefit compared with POCT.…”

Comparison of survival results of patients with T0 and T1-2-3 in pathological T staging in patients with non-small cell lung cancer who underwent surgery after neoadjuvant treatment

“…In NSCLC stage IIIA-N2 disease, neoadjuvant chemotherapy or chemoradiotherapy allows complete resection of the tumor by regressing the stage and decreases the possibility of distant metastasis by providing systemic control in the early period [ 19 , 20 ]. However, a standard multimodal approach could not be defined in these patients.…”

<p>Radiotherapy for patients with completely resected pathologic IIIA(N2) non–small-cell lung cancer: a retrospective analysis</p>

“…Patients who underwent complete removal of stage IIIA (N2) NSCLC are at risk of local and distant recurrence 7 Adjuvant chemotherapy has been accepted as a part of the standard postoperative treatment of patients with NSCLC, including those with N2 disease. [17][18][19][20] In recent years, with the significant improvement of technology, the simulation, planning and delivery of radiotherapy have been optimized.…”

“…[1][2][3] Based on several prospective clinical trials that have validated the survival benefit of concurrent chemoradiotherapy over radiotherapy alone 4 or chemotherapy followed by sequential radiotherapy for stage IIIA (N2) NSCLC. 5,6 However, stage IIIA (N2) NSCLC patients have heterogeneous disease presentation, 7 the value of postoperative adjuvant radiotherapy(PORT) for completely resected NSCLC remains controversial, as the effect on survival has been inconclusive. [8][9][10] A secondary analysis of a prospective trial illustrated the benefit of adding PORT in pN2 disease regardless of chemotherapy use, 11 this has been supported by multiple high-volume retrospective investigations.…”