Radiation Therapy–First Strategy After Surgery With or Without Adjuvant Chemotherapy in Stage IIIA-N2 Non-Small Cell Lung Cancer

• Published in: International journal of radiation oncology, biology, physics Vol. 94; no. 3; pp. 621 - 627
• Main Authors: Lee, Hyun Woo, MD, Noh, O Kyu, MD, PhD, Oh, Young-Taek, MD, PhD, Choi, Jin-Hyuk, MD, PhD, Chun, Mison, MD, PhD, Kim, Hwan-Ik, MD, Heo, Jaesung, MD, MS, Ahn, Mi Sun, MD, MS, Park, Seong Yong, MD, MS, Park, Rae Woong, MD, PhD, Yoon, Dukyong, MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2016
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Adult; Aged; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Non-Small-Cell Lung - surgery; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; CHEMOTHERAPY; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Lung Neoplasms - surgery; LUNGS; Male; Middle Aged; NEOPLASMS; PATIENTS; Postoperative Period; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Adjuvant - mortality; Radiotherapy, Conformal; SURGERY; Time Factors; Treatment Outcome
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2015.11.020

Purpose Postoperative radiation therapy (PORT) and postoperative chemotherapy (POCT) can be administered as adjuvant therapies in patients with non-small cell lung cancer (NSCLC). The aim of this study was to present the clinical outcomes in patients treated with PORT-first with or without subsequent POCT in stage IIIA-N2 NSCLC. Methods and Materials From January 2002 to November 2014, the conditions of 105 patients with stage IIIA-N2 NSCLC who received PORT-first with or without subsequent POCT were analyzed. PORT was initiated within 4 to 6 weeks after surgical resection. Platinum-based POCT was administered 3 to 4 weeks after the completion of PORT. We analyzed the outcomes and the clinical factors affecting survival. Results Of 105 patients, 43 (41.0%) received POCT with a median of 4 cycles (range, 2-6 cycles). The follow-up times ranged from 3 to 123 months (median, 30 months), and the 5-year overall survival (OS) was 40.2%. The 5-year OS of patients treated with PORT and POCT was significantly higher than that of patients with PORT (61.3% vs 29.2%, P <.001). The significant prognostic factors affecting OS were the use of POCT (hazard ratio [HR] = 0.453, P =.036) and type of surgery (pneumonectomy/lobectomy; HR = 2.845, P <.001). Conclusions PORT-first strategy after surgery appeared not to compromise the clinical outcomes in the treatment of stage IIIA-N2 NSCLC. The benefit of POCT on OS was preserved even in the PORT-first setting. Further studies are warranted to compare the sequencing of PORT and POCT, guaranteeing the proper use of POCT.