Postoperative Radiotherapy for Stage II or III Non–Small-Cell Lung Cancer Using the Surveillance, Epidemiology, and End Results Database

Lally, Brian E.; Zelterman, Daniel; Colasanto, Joseph M.; Haffty, Bruce G.; Detterbeck, Frank C.; Wilson, Lynn D.

doi:10.1200/jco.2005.04.6110

Cited by 432 publications

(323 citation statements)

References 20 publications

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“…Using the surveillance, epidemiology, and end results database (SEER), Lally et al investigated the association between survival and postoperative radiotherapy (PORT) in patients with resected NSCLC. In a population-based cohort, PORT use was associated with an increase in survival in patients with N2 nodal disease but not in patients with N1 and N0 nodal disease (32). These data were verified by Douillard et al who studied the impact of PORT on survival of patients recruited in the Adjuvant Navelbine International Trialist Association (ANITA) randomized study of adjuvant chemotherapy (33).…”

Section: The Diagnosis Of Residual N2 Diseasementioning

confidence: 73%

Perspectives on the effect of nodal downstaging and its implication of the role of surgery in stage IIIA (N2) non-small cell lung cancer

Martin

Mehran

2017

J. Thorac. Dis.

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Section: The Diagnosis Of Residual N2 Diseasementioning

confidence: 73%

Perspectives on the effect of nodal downstaging and its implication of the role of surgery in stage IIIA (N2) non-small cell lung cancer

Martin

Mehran

2017

J. Thorac. Dis.

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“…Analysis of randomised controlled trials and national databases has not suggested an overall survival benefit with PORT, although some data suggest a prognostic benefit in those patients with N2 disease. [56][57][58] The ongoing Lung Adjuvant Radiation Trial aims to assess PORT in patients with resected N2 NSCLC. 59 Postoperative radiotherapy may also be of possible benefit in patients with N0 disease with incomplete resection margins.…”

Section: Descriptormentioning

confidence: 99%

Advances in the prevention and treatment of lung cancer

Sethi²

2011

J R Coll Physicians Edinb

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Lung cancer remains the most common fatal malignancy in the Western world. Survival rates have only improved modestly over the past three decades and new approaches are urgently required. It is clear that a concerted effort to reduce cigarette smoking is required. However, about 10% of patients with lung cancer are never smokers, indicating genetic or other predisposition. Lung cancer screening programmes are being trialled to target high-risk populations. Genetic strategies will provide new methods for screening and predicting response to treatment. Current therapy for lung cancer has reached a plateau and novel agents have shown modest clinical efficacy. Understanding the mechanisms by which chronic inflammatory disorders such as chronic obstructive pulmonary disease contribute to lung cancer development will help to identify new biological targets and biomarkers of early disease. This review focuses on recent advances in lung cancer prevention and treatment.

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“…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).…”

mentioning

confidence: 99%

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

Kępka¹,

Socha²,

Rucińska³

et al. 2016

J. Thorac. Dis.

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This editorial comments on the study by Lee et al. which reported on the use of postoperative radiotherapy (PORT) as first strategy after resection of stage IIIA-pN2 non-small cell lung cancer (NSCLC).After completion of PORT, 41% of patients received postoperative chemotherapy (POCT). The five-year overall survival (OS) was significantly higher in patients treated with PORT and POCT than in patients treated with PORT alone. Authors concluded that PORT used as first postoperative strategy does not compromise a benefit of POCT and its implementation should be further studied. We discuss the pros and cons of using PORT before POCT for stage IIIA-pN2 NSCLC. Some radiobiological data support earlier use of PORT, however, caution should be paid to not to unnecessarily delay or omit POCT because of its demonstrated survival benefit. Concurrent postoperative radio-chemotherapy could be an attractive approach, but we still have very limited clinical data on its use in this indication. after surgical resection (44-45 Gy for a bronchial stump, involved mediastinal nodal stations, and its next draining stations and a boost up to 50.4-60 Gy for a bronchial stump and involved nodal stations). POCT (4-6 cycles of platinum-based chemotherapy administered 3 to 4 weeks after the completion of PORT) was given for 43 patients (41%). Thirty patients (48.4%) did not receive POCT because of comorbidities, 23 patients (37.1%) because of institutional policy, 8 patients (12.9%) because of refusal of treatment, and one patient (1.6%) because of old age. There were no significant differences in loco-regional and distant failure between the groups with and without POCT. The 5-year OS was significantly higher in the group with POCT than in group without POCT: 61.3% vs. 29.2%, respectively, P<0.001. There was no significant difference in the loco-regional recurrence free survival between the groups. 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. The main limitation of the presented study is its retrospective nature and-in consequence-an imbalance in the main prognostic factors between the presented groups. Patients in the POCT arm were younger, showed significantly better performance status and had lower comorbidity index, which could impact the obtained result. Homogenous treatment protocol was probably provided for all cases, but the total radiation dose actually administered in the POCT group was higher. PORT was probably interrupted in some no-POCT patients due to clinically important reasons. One may presume that the patients who died or progressed during PORT ...

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Postoperative Radiotherapy for Stage II or III Non–Small-Cell Lung Cancer Using the Surveillance, Epidemiology, and End Results Database

Abstract: In a population-based cohort, PORT use is associated with an increase in survival in patients with N2 nodal disease but not in patients with N1 and N0 nodal disease.

Cited by 432 publications

References 20 publications

Perspectives on the effect of nodal downstaging and its implication of the role of surgery in stage IIIA (N2) non-small cell lung cancer

Perspectives on the effect of nodal downstaging and its implication of the role of surgery in stage IIIA (N2) non-small cell lung cancer

Advances in the prevention and treatment of lung cancer

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

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