Postoperative intensity‐modulated radiation therapy reduces local recurrence and improves overall survival in III‐N2 non‐small‐cell lung cancer: A single‐center, retrospective study

Abstract

Purpose:To determine the postoperative effects of radiotherapy (PORT) on the local recurrence-free survival (LRFS) and overall survival (OS) of stage III-N2 nonsmall-cell lung cancer (NSCLC). Materials and Methods: 183 patients with resected stage III-pN2 NSCLC from Hunan Cancer Hospital between 2013 and 2016 were divided into two groups for postoperative chemotherapy (POCT) (n = 105) or combination chemotherapy and radiotherapy (POCRT) (n = 78). The LRFS and OS were compared and the factors affecting local recurrence were illustrated in these two groups. The sites of failure based on the lobe of the primary tumor in two groups were described. Results: PORT leads to a strikingly lower risk for local recurrence and brought superior OS benefit. For different pN2 Subclassification, Patients with multiple-station pN2 ± pN1 disease had the worst LRFS (11 months) and single-station pN2 + multiple station pN1 disease had a relatively short LRFS (24 months) in group POCT. Short LRFS is correlated with multiple-station pN2, older age (Y > 55), patients with a high positive LN ratio > 1/3 and a poor tumor histological differentiation degree. In group POCT, the most frequent failure site occurs at the ipsilateral hilum (21.0%), the bronchial stump (20.0%), followed by LNs4R (19.0%), LNs4L (18.1%), LNs7 (15.2%), most of left-sided tumors more frequently involved the contralateral mediastinum, whereas the ipsilateral recurrences dominated for right-sided tumors, especially for LNs4R. In group POCRT, the highest failure site was the bronchial stump (11.5%), followed by LNs4L (8.97%), LNs1 (7.69%), the ipsilateral hilum (6.41%) and LNs4R (6.41%). Conclusion: PORT remarkably reduced local recurrence and improved OS in stage III-pN2 NSCLC, especially in the multiple-station pN2 group. CorrespondenceZhi-Gang Liu, The cancer center of the fifth affiliated hospital

Supraclavicular Recurrence in Completely Resected (y)pN2 Non-Small Cell Lung Cancer: Implications for Postoperative Radiotherapy

“…The cumulative incidence of postoperative recurrence in the PORT group and non-PORT group, were generally comparable with recent studies (7,9,17,23). Furthermore, studies from our institution (7) and others (16,24) had reported a similar percentage of SCR among patients with recurrent disease (7.7-11.6% in the literature, 13.3% in our study). Compared with their counterpart, patients staged cN2 or ypN2 generally had a more advanced and aggressive disease, and thus it was reasonable for them to have a higher risk developing disease recurrence, including SCR (17,(25)(26)(27).…”

“…The clinical value of PORT in completely resected (y)pN2 NSCLC was demonstrated again in our study, but the delineation of CTV remain controversial. In the current study, PORT significantly reduced LRR and improved OS1, which have been demonstrated in various studies ( 5 , 6 , 8 – 11 , 16 , 17 , 23 ). However, since ESRT was not routinely performed in our cancer institution ( 7 ), PORT failed to reduce SCR, indicating that the majority of SCRs represented the outgrowth of subclinical tumor lesions already in the supraclavicular region and were not originated from the loco-regional recurrent disease through lymphatic metastasis.…”

“…In these studies, cumulative incidence, anatomic locations, and risk factors of LRR were extensively examined. However, the definitions of LRR are different, some of which include the initial disease recurrence developed in the supraclavicular region (SCR) (9,16), while others don't (7,17). Investigations specifically focused on SCR are seldom reported and elective supraclavicular nodal irradiation (ESRT) is not routinely performed.…”

Clinical, pathological and treatment factors associated with the survival of patients with pulmonary sarcomatoid carcinoma

“…The role of radiotherapy in patients with PSC is poorly defined (29). Radiotherapy has been used alone and in combination with chemotherapy in patients with unresectable disease or in an adjuvant setting for those with high rates of recurrence (30). Clinically, radiotherapy is always reserved for patients with rare types of lung cancer (31,32).…”

Patient prognostic scores and association with survival improvement offered by postoperative radiotherapy for resected IIIA/N2 non‐small cell lung cancer: A population‐based study

“…These results made us more confident that patients who received PORT had a better survival rate. The reasons for this may be that PORT can eliminate regions of microscopic disease, and thus reduce locoregional recurrence and improve survival 16,29,30 . In addition, compared with older techniques that increased the risk of cardiac and pulmonary toxicity, more modern radiation techniques have become safer and bring a greater survival benefit for patients treated with PORT 8,31 …”