Postoperative Radiotherapy for Pathologic N2 Non–Small-Cell Lung Cancer Treated With Adjuvant Chemotherapy: A Review of the National Cancer Data Base

Abstract

Purpose To investigate the impact of modern postoperative radiotherapy (PORT) on overall survival (OS) for patients with N2 non–small-cell lung cancer (NSCLC) treated nationally with surgery and adjuvant chemotherapy. Patients and Methods Patients with pathologic N2 NSCLC who underwent complete resection and adjuvant chemotherapy from 2006 to 2010 were identified from the National Cancer Data Base and stratified by use of PORT (≥ 45 Gy). A total of 4,483 patients were identified (PORT, n = 1,850; no PORT, n = 2,633). The impact of patient and treatment variables on OS was explored using Cox regression. Results Median follow-up time was 22 months. On univariable analysis, improved OS correlated with younger age, treatment at an academic facility, female sex, urban population, higher income, lower Charlson comorbidity score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT. On multivariable analysis, improved OS remained independently predicted by younger age, female sex, urban population, lower Charlson score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT (hazard ratio, 0.886; 95% CI, 0.798 to 0.988). Use of PORT was associated with an increase in median and 5-year OS compared with no PORT (median OS, 45.2 v 40.7 months, respectively; 5-year OS, 39.3% [95% CI, 35.4% to 43.5%] v 34.8% [95% CI, 31.6% to 38.3%], respectively; P = .014). Conclusion For patients with N2 NSCLC after complete resection and adjuvant chemotherapy, modern PORT seems to confer an additional OS advantage beyond that achieved with adjuvant chemotherapy alone.

Complete resolution of refractory hypercalcemia following pneumonectomy in squamous cell carcinoma of the lung

“…Modest improvements in overall survival have been observed in patients receiving adjuvant chemotherapy; however, these patients never received pre-operative chemotherapy, therefore it is not directly comparable [10] . Post-operative radiotherapy is not routinely used for completely resected early stage lung cancer (I + II), although patients with N2 disease can be considered for it [11] .…”

Sequencing postoperative radiotherapy and adjuvant chemotherapy in non-small cell lung cancer: unanswered questions on the not evidence-based approach

“…The authors concluded that the PORT-first strategy after surgery for stage IIIA (pN2) NSCLC patients did not compromise the clinical outcomes, and that the OS benefit of POCT given after PORT was observed. Since the OS was superior to that obtained in the historical series in which PORT was applied after POCT (3,9,12), the authors suggested that the use of PORT before rather than after POCT may have contributed to this improvement. Such conclusions obviously have their limitations, also acknowledged by the authors.…”

“…Modern series of PORT show promising results with very low toxicity (3,(7)(8)(9). Population-based studies support the use of PORT also with adjuvant chemotherapy for pN2 patients, in contrast to pN0 and pN1 patients in whom PORT was associated with reduction of survival (10)(11)(12).…”

What is the optimal adjuvant therapy for T3N0 lung cancer invading the chest wall?

“…The benefit of PORT for these patients had been controversial (9,10) until the results of the Lung ART study (11). However, a recent retrospective study and meta-analysis of PORT demonstrated that it had a positive effect (12,13).…”