Postoperative radiotherapy in pIIIA-N2 Non–Small Cell Lung Cancer after resection and chemotherapy

1. Postoperative radiotherapy for pIIIA-N2 non-small cell lung cancer did not improve disease-free survival or overall survival, but did improve locoregional recurrence-free survival.

Evidence Rating Level: 1 (Excellent)

The use of postoperative radiotherapy (PORT) has been correlated with increased survival for non-small cell lung cancer (NSCLC) patients, particularly the pN2 NSCLC subtype. However, it is unclear if PORT is associated with prolonged survival in pIIIA-N2 NSCLC patients, including patients who receive adjuvant chemotherapy. The current phase 3 randomized controlled trial aimed to determine the effect of PORT on disease-free survival (DFS) for pIIIA-N2 NSCLC patients, after having undergone a complete resection and 4 cycles of adjuvant chemotherapy. This was a single institution study based in China, with 140 patients receiving PORT and 170 patients in the observation group. PORT was done within 6 weeks after the last chemotherapy cycle, and the median follow-up was 46.0 (95% CI 41.9-51.4) months. Overall, no significant difference was found in disease-free survival between the two groups: The median DFS was 22.1 (95% CI 14.8-29.3) months for the PORT group and 18.6 (95% CI 14.3-23.0) months for the observation group. After 3 years, the DFS was 40.5% and 32.7% respectively. Additionally, overall survival was not significantly different between the PORT and observation cohorts (3-year overall survival of 78.3% and 82.8% respectively, hazards ratio 1.02, 95% CI 0.68-1.52, p = 0.93), but the locoregional recurrence-free survival rates were greater in the PORT group (66.5% versus 59.7%, HR 0.71, 95% CI 0.51-0.97, p = 0.03). No adverse events from the radiotherapy were observed. In conclusion, the use of PORT did not improve disease-free survival or overall survival, but was associated with an improvement in locoregional recurrence-free survival.

Click to read the study in JAMA Oncology

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