Abstract

Objective To compare the efficacy of postoperative concurrent radiochemotherapy (POCRT) and postoperative chemotherapy (POCT) alone on Ⅲa-pN2 non-small cell lung cancer (NSCLC).Methods A total of 140 postoperative patients with Ⅲ a-pN2 NSCLC were randomly divided into 2 equal groups:POCRT and POCT groups.For chemotherapy paclitaxel at a dose of 175 mg/m2 and cisplatin a dose of 60 mg/m2 were injected intravenously at 1,22,43,and 64 d.Totally 4 cycles were adopted with an interval of 21 d.The patients in the POCRT group additionally received radiotherapy (50.4 Gy/28 times) at 1 d of treatment.Follow-up was conducted at least 5 years or until the death of the patients.Results The 5-year overall survival rate of the POCRT group was 37.9％,and the POCT group was 27.5％.The hazard ratio for death of the POCRT group was 0.69 (95％ CI:0.457-1.044,x2 =3.224,P ＞ 0.05).The 5-year relapse-free survival ra(lt)()the POCRT group was 30.3％,and the POCT group was 18.8％.The recurrence hazard ratio of the POCT group was 1.49 (95％ CI:1.008-2.204,x2 =4.193,P ＜ 0.05).Subgroup analysis revealed that POCRT significantly increased the overall survival rate of the patients with ≥2 pN2 lymph nodes (x2 =5.308,P ＜ 0.05).The POCRT group had a significantly lower relapse (x2 =5.308,P ＜ 0.05) and distant metastasis (x2 =3.840,P ＜ 0.05) rates as compared to that of the POCT group.One case died of pyemia and 9 cases who suffered from grades 3 or 4 radiation esophagitis.These 2 groups showed similar and tolerable hematologic toxicities.Conclusions Compared with POCT,POCRT significantly reduces the local relapse and distant metastasis rates,and increases the relapse-free survival rate of the patients with Ⅲa-pN2 NSCLC,however,it fails to raise the overall survival rate. Key words: Non-small cell lung cancer; Surgery; Ⅲa-pN2; Postoperative concurrent radiochemotherapy ; Survival

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