Postoperative Radiotherapy for Resected Pathological Stage IIIA–N2 Non‐Small Cell Lung Cancer: A Retrospective Study of 221 Cases from a Single Institution

• Published in: The oncologist (Dayton, Ohio) Vol. 16; no. 5; pp. 641 - 650
• Main Authors: Dai, Honghai, Hui, Zhouguang, Ji, Wei, Liang, Jun, Lu, Jima, Ou, Guangfei, Zhou, Zongmei, Feng, Qinfu, Xiao, Zefen, Chen, Dongfu, Zhang, Hongxing, Yin, Weibo, He, Jie, Wang, Luhua
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.01.2011
• Subjects: Aged; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Non-Small-Cell Lung - surgery; Chemotherapy, Adjuvant; Disease-Free Survival; Female; Humans; IIIA‐N2; Lung Cancer; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Lung Neoplasms - surgery; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Non‐small cell lung cancer; Postoperative Period; Postoperative radiotherapy; Randomized Controlled Trials as Topic; Retrospective Studies; Surgery; Survival; Survival Analysis
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2010-0343

Learning Objectives After completing this course, the reader will be able to: Describe the present clinical practice and controversies regarding the use of PORT in resected pIIIA‐pN2 NSCLC. Evaluate the effect of PORT on overall survival and on tumor control in this subgroup of patients. This article is available for continuing medical education credit at CME.TheOncologist.com Background. For patients with resected pathological stage IIIA–N2 non‐small cell lung cancer (NSCLC), the role of postoperative radiotherapy (PORT) is not well defined. In this single‐institutional study, we re‐evaluated the effect of PORT on overall survival (OS) as well as tumor control in this subgroup of patients. Methods. In 2003–2005, 221 consecutive patients with resected pathological stage IIIA–N2 NSCLC at our institution were retrospectively analyzed in an institutional review board–approved study. The effect of PORT on OS, cancer‐specific survival (CSS), and disease‐free survival (DFS) was evaluated using the Kaplan–Meier method and log‐rank tests. The impact of PORT on locoregional control and distant metastasis was also analyzed. Results. Compared with the control, patients treated with PORT had a significantly longer OS time (χ2, 3.966; p = .046) and DFS interval (χ2, 6.891; p = .009), as well as a trend toward a longer CSS duration (χ2, 3.486; p = .062). Patients treated with PORT also had a significantly higher locoregional recurrence‐free survival rate (χ2, 5.048; p = .025) as well as distant metastasis‐free survival rate (χ2, 11.248; p = .001). Multivariate analyses showed that PORT was significantly associated with a longer OS duration (p = .000). Conclusions. PORT can significantly improve the survival of patients with resected pathological stage IIIA–N2 NSCLC. A prospective randomized multicenter clinical trial is ongoing. 摘要 背景：非小细胞肺癌（NSCLC）切除后病理分期为IIIA‐N2的患者中，术后放疗（PORT）的作用并未明确。本项单中心研究中，研究者重新评价了PORT对该亚组患者总生存（OS）和肿瘤局部控制的疗效。 方法：对本机构2003 ~ 2005年NSCLC完全性切除后病理分期为IIIA‐N2的221例连续患者进行回顾性分析。本研究通过了伦理委员会批准。用Kaplan‐Meier方法和 log‐rank检验，分析PORT对OS、癌症特异生存（CSS）和无病生存（DFS）的效应。同时分析PORT对肿瘤局部/区域控制和远处转移的效应。 结果：与对照组相比，接受PORT的患者总生存时间（χ2 = 3.966，P = 0.046）和DFS间期（χ2 = 6.891，P = 0.009）显著延长，CSS期也有延长趋势（χ2= 3.486，P = 0.062）。接受PORT的患者局部/区域无复发生存率（χ2= 5.048，P= 0.025）和无远处转移生存率（χ2= 11.248，P = 0.001）也较高。多因素分析显示，PORT与总生存时间延长显著相关（P = 0.000）。 结论：PORT可显著改善NSCLC完全性切除术后病理分期为IIIA‐N2患者的生存。一项前瞻性、多中心、随机临床研究正在进行中。 The effect of postoperative radiotherapy on overall survival and tumor control in patients with resected pathological stage IIIA–N2 non‐small cell lung cancer was evaluated.