Nodal Stage of Surgically Resected Non-Small Cell Lung Cancer and Its Effect on Recurrence Patterns and Overall Survival

Varlotto, John M.; Yao, Aaron; DeCamp, Malcom McAvoy; Ramakrishna, S.; Recht, A.; Flickinger, John C.; Andrei, Adin Cristian; Reed, Michael F.; Toth, Jennifer; Fizgerald, Thomas J.; Higgins, Kristin; Xiao, Zheng; Shelkey, Julia; Medford‐Davis, Laura N.; Belani, Chandra P.; Kelsey, Chris R.

doi:10.1016/j.ijrobp.2014.12.028

Cited by 39 publications

(36 citation statements)

References 29 publications

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“…Finally, factors predictive of first DM within prognostically unfavorable sites were nonsquamous histology for liver and a delay between diagnoses and RT and advanced initial stage for bone (Table 2). Our observed frequency of DM failure (42%) is consistent with that presented in other studies assessing treated with definitive radiation (ranging 33-59%) [1][2][3] and higher than those assessing definitive surgical management (range 23-42%) [16][17][18]. Predictors of DM after definitive treatment for NSCLC have been elucidated in a number of reports.…”

Section: Discussionsupporting

confidence: 89%

Prognosis and predictors of site of first metastasis after definitive radiation therapy for non-small cell lung cancer

et al. 2016

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Section: Discussionsupporting

confidence: 89%

Prognosis and predictors of site of first metastasis after definitive radiation therapy for non-small cell lung cancer

et al. 2016

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“…Each visit included a medical history, physical examination, complete blood count, chest and upper abdominal computed tomography (CT), brain magnetic resonance imaging/CT and a bone scan (if deemed to be necessary due to complaint of pain). Local recurrence was defined as disease relapse at the BS, ipsilateral hilum and mediastinum; all other sites of failure, including the supraclavicular fossa and contralateral hilum, were considered to be distant metastases (24,25). Disease progression was diagnosed with confirmed biopsy or positive imaging findings.…”

Section: Follow-upmentioning

confidence: 99%

Association between clinicopathological factors and postoperative radiotherapy in patients with completely resected pathological N2 non-small cell lung cancer

Wang

et al. 2017

Oncol Lett

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Abstract. The function of postoperative radiotherapy (PORT) in patients with completely resected pathologically N2 (pN2) non-small cell lung cancer (NSCLC) remains controversial due to a lack of prospective studies. The present study aimed to evaluate the efficacy of PORT in completely resected pN2 NSCLC when using modern radiation techniques, and to determine the associations between clinicopathological factors and PORT and survival rates. Following patient selection, 246 out of 269 consecutive patients with pN2 NSCLC were enrolled in the present study, with 88 patients having received postoperative chemotherapy (POCT) and PORT, 90 having received adjuvant chemotherapy, 1 having received adjuvant radiotherapy and the remaining 67 having received no adjuvant therapy. Overall survival (OS), local recurrence-free survival (LRFS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. The median age of the patients was 59 years, overall, 175 (71.1%) of the patients were male and the median radiation dose was 50.4 Gy. The median follow-up duration was 38.3 months. The 1-, 3-and 5-year OS rates were 98.9, 71.3 and 54.9%, and 93.0, 58.4 and 36.7% (P=0.011) in the PORT and non-PORT group, respectively. The 1-, 3-and 5-year LRFS rates were 95.5, 84.6 and 78.0%, and 86.6, 70.6 and 52.8% (P<0.001) in the PORT and non-PORT groups, respectively. The 1-, 3-and 5-year DFS rates were 86.5, 55.2 and 37.9%, and 80.9, 40.3 and 26.8% (P=0.132) in the PORT and non-PORT groups, respectively. Univariate analysis revealed that the OS rate was significantly increased in patients with peripheral tumors (P=0.029), pT1-2 (P=0.015), one N2 lymph node (LN) metastasis (P=0.001), single N2 station metastasis (P=0.030), no bronchial involvement (P=0.025), use of PORT (P=0.011) and POCT (P=0.003). Multivariate analysis revealed that PORT (HR, 0.755; 95% CI, 0.498-0.986; P=0.047), POCT (HR, 0.645; 95% CI, 0.420-0.988; P=0.044), bronchial involvement (HR, 1.453; 95% CI, 1.002-2.107; P= 0.049) and ≥2 N2 metastases (HR, 1.969; 95% CI, 1.228-3.157; P= 0.005) were significant independent predictors of OS. Subgroup analysis demonstrated an increased OS rate with PORT only in the patients with positive bronchial involvement and ≥2 N2 LN metastases. The results revealed that PORT may improve the LRFS and OS rates in completely resected pN2 NSCLC, and that the patients with positive bronchial involvement and ≥2 N2 LN metastases may receive more benefit from PORT.

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“…PORT is considered on a case-by-case basis and may be recommended particularly for patients with good performance status, close margins, advanced T stage, limited lymph node dissection, and/or multiple station N2 disease. However, further studies are needed to better define patient subsets that are more likely to derive benefit from PORT 17, 18. Additionally, molecular markers are needed to identify patients who are at a higher risk for LRR versus DM recurrence.…”

Section: Discussionmentioning

confidence: 99%

Predictors of relapse and evaluation of the role of postoperative radiation therapy in a modern series of patients with surgically resected stage III (N2) non–small cell lung cancer

Breen

Merrell

Mansfield

et al. 2017

Advances in Radiation Oncology

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PurposeFor patients with stage III (N2) non–small cell lung cancer (NSCLC) treated with surgical resection, postoperative chemotherapy improves overall survival (OS), but the role of postoperative radiation therapy (PORT) is controversial. The purpose of this study was to evaluate risk factors for local-regional recurrence and to evaluate the impact of PORT on local-regional control (LRC) and OS in a modern series of patients with surgically resected stage III (N2) NSCLC.Methods and materialsA retrospective review was performed of patients with Stage III (N2) NSCLC who underwent curative intent resection at our institution between February 1999 and January 2012. OS, LRC, and metastasis-free survival were estimated from the date of surgery using the Kaplan Meier method.ResultsA total of 71 patients were included in the study. Patient median age was 63 years. Histology was adenocarcinoma in 69% of patients. Pretreatment positron emission tomography/computed tomography staging was performed for 90% of patients, and preoperative chemotherapy was administered in 23%. The rate of R0 resection was 96%. Forty-one patients (58%) received PORT and the median PORT dose was 50 Gy (range, 41.4-60 Gy). The median follow-up time for living patients was 5.0 years. Five-year OS for all patients was 66%. OS at 5 years for patients who received PORT compared with patients who did not receive PORT was 71% versus 60%, respectively (hazard ratio [HR], 0.61; 95% CI, 0.30-1.44; P = .28). LRC at 5 years for patients who received PORT compared with patients who did not receive PORT was 89% versus 76%, respectively (HR, 0.44; 95% CI, 0.13-1.45; P = .17). Factors associated with decreased LRC were male sex (P = .011) and primary tumor (pT) stage (pT3/4 vs. pT1/2, P = .006). Metastasis-free survival at 5 years for patients who received PORT compared with those who did not receive PORT was 62% versus 63%, respectively (HR, 1.07; 95% CI, 0.51-2.40; P = .86).ConclusionsIn this modern series of patients with resected stage III (N2) NSCLC, patients who received PORT had higher rates of OS and LRC, but these differences were not statistically significant.

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Nodal Stage of Surgically Resected Non-Small Cell Lung Cancer and Its Effect on Recurrence Patterns and Overall Survival

Cited by 39 publications

References 29 publications

Prognosis and predictors of site of first metastasis after definitive radiation therapy for non-small cell lung cancer

Prognosis and predictors of site of first metastasis after definitive radiation therapy for non-small cell lung cancer

Association between clinicopathological factors and postoperative radiotherapy in patients with completely resected pathological N2 non-small cell lung cancer

Predictors of relapse and evaluation of the role of postoperative radiation therapy in a modern series of patients with surgically resected stage III (N2) non–small cell lung cancer

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