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

Abstract

Background: The clinical value and delineation of clinical target volume (CTV) of postoperative radiotherapy (PORT) in completely resected (y)pN2 non-small cell lung cancer (NSCLC) remain controversial. Investigations specifically focusing on the cumulative incidence and prognostic significance of initial disease recurrence at the supraclavicular region (SCR) in this disease population are seldom reported. Methods: Consecutive patients with curatively resected (y)pN2 NSCLC who received adjuvant chemotherapy from January 2013 to December 2018 at our cancer center were retrospectively examined. Disease recurrence at the surgical margin, ipsilateral hilum, and/or mediastinum was defined as loco-regional recurrence (LRR). Disease recurrence beyond LRR and SCR, was defined as distant metastasis (DM). Overall survival (OS1 and OS2) were calculated from surgery and disease recurrence to death of any cause, in the entire cohort and in patients with recurrent disease, respectively. Results: Among the 311 patients enrolled, PORT without elective supraclavicular nodal irradiation (ESRT) was performed in 94 patients and neoadjuvant chemotherapy was administered in 31 patients. With a median follow-up of 26 months, 203 patients developed recurrent disease, including 27 SCRs, among which 16 were without DM and 22 involved the ipsilateral supraclavicular region. The 1, 3, and 5-year cumulative incidence of SCR were 6.53, 13.0, and 24.7%, respectively. Chosen DM as a competing event, cN2, ypN2, not receiving lobectomy, and negative expression of CK7 were significantly associated with SCR using the univariate competing risk analysis, while ypN2 was identified as the only independent risk factor of SCR (p = 0.012). PORT significantly reduced LRR (p = 0.031) and prolonged OS1 (p = 0.018), but didn't impact SCR (p = 0.254). Pattern of failure analyses indicated that the majority of LRRs developed within the actuarial or virtual CTV of PORT, and 15 of the 22 ipsilateral SCRs could be covered by the virtual CTV of proposed ESRT. In terms of OS2, patients who developed SCR but without DM had intermediate prognosis, compared with those who had DM (p = 0.009) and those who had only LRR (p = 0.048). Liu et al. Supraclavicular Recurrence in (y)pN2 NSCLC Conclusions: SCR is not uncommon and has important prognostic significance in completely resected (y)pN2 NSCLC. The clinical value of PORT and ESRT in such patients need to be further investigated.

Is there role of adjuvant radiotherapy after complete resection of locally advanced nonsmall cell lung cancer?

“…Despite these promising results, less than one-third of participants presented with stage III-N2 disease and the impact of osimertinib on local control in the EGFR mutation population remains unclear. Interestingly, the Lung ART trial found significantly lower mediastinal relapse rates in the group receiving PORT, adding complexity to the debate on postoperative management of EGFR-mutated NSCLC [8 ▪▪ ,30,31].…”

Traditional Herbal Medicine: A Potential Therapeutic Approach for Adjuvant Treatment of Non-small Cell Lung Cancer in the Future

“…JFK is composed of 12 herbs, including 97 In addition, clinical reports have shown that JFKD combined with cisplatin chemotherapy prolongs survival in patients with stage II/III NSCLC, improves immune parameters and reduces cisplatin-related side effects. [98][99][100] Buzhong Yiqi (BZYQ) decoction (BZYQD) first appeared in the book "Spleen and Stomach Theory" by Li Dongyuan >700 years ago, which focused on prescriptions for treating visceral ptosis, chronic gastrointestinal diarrhea, and other spleen and stomach diseases. 101 Previous studies reported that high concentrations of BZYQ can cause gastric cancer and ovarian neoplasm tumor cell death by regulating apoptosis.…”

Establishment and Validation of an Integrated Model to Predict Postoperative Recurrence in Patients With Atypical Meningioma

“…In addition to the first reexamination within 1 month after surgery, patients were regularly screened for recurrence by contrast-enhanced CT or MRI every 3 months in the first year, every 6 months in the second year, and annually thereafter. The primary endpoint was recurrence-free survival (RFS), defined as the time from surgery to initial recurrence (12).…”