Early postoperative radiotherapy is associated with improved outcomes over late postoperative radiotherapy in the management of completely resected (R0) Stage IIIA-N2 non-small cell lung cancer

Huan-Huan Wang,Ping Wang,Lei Deng,Bo Jiang,Yao-Li Cui,Lu-Jun Zhao,Hai-Ling Hou,Qing-Song Pang,Chun-Ze Zhang,Wei Wang,Nicholas G Zaorsky,Xian-Liang Zeng,Zhi-Yong Yuan,Qing-Lian Wen,Mao-Bin Meng,Yang-Yang Shi,Jie Chen,Bai-Lin Zhang,Jun Wang

doi:10.18632/oncotarget.18071

Abstract

AimsThe aim of this study was to evaluate the ideal timing of PORT in the management of completely resected (R0) Stage IIIA-N2 NSCLC.Patients and MethodsBetween January 2008 and December 2015, patients with known histologies of pathologic Stage IIIA-N2 NSCLC who underwent R0 resection and received PORT concurrent with or prior to two sequential cycles of chemotherapy (“early PORT”) or with PORT administered after two cycles of chemotherapy (“late PORT”) at multiple hospitals. The primary endpoint was OS; secondary end points included pattern of the first failure, LRRFS, and DMFS. Kaplan–Meier OS, LRRFS, and DMFS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS, LRRFS, and DMFS.ResultsOf 112 included patients, 41 (36.6%) and 71 (63.4%) patients received early PORT and late PORT, respectively. The median OS, LRRFS, and DMFS were longer for those who received early PORT than for those who received late PORT at the median follow-up of 29.6 months (all p < 0.05). Uni- and multi-variate analyses showed that number of POCT cycles and the combination schedule of PORT and POCT were independent prognostic factors for OS, LRRFS, and DMFS.ConclusionsEarly PORT is associated with improved outcomes in pathologic Stage IIIA-N2 R0 NSCLC patients.

Highlights

Surgery is a treatment option for certain non-small cell lung cancer (NSCLC) patients, including those with localized (i.e. Stage I-II) and few patients locally advanced (i.e. Stage IIIA) disease
Uni- and multi-variate analyses showed that number of postoperative chemotherapy (POCT) cycles and the combination schedule of postoperative radiotherapy (PORT) and POCT were independent prognostic factors for overall survival (OS), locoregional recurrence-free survival (LRRFS), and distant metastasisfree survival (DMFS)
Early PORT is associated with improved outcomes in pathologic Stage IIIA-N2 R0 NSCLC patients

Summary

Introduction

Surgery is a treatment option for certain NSCLC patients, including those with localized (i.e. Stage I-II) and few patients locally advanced (i.e. Stage IIIA) disease. The vast majority of post-operative NSCLC patients are recommended to receive POCT, with or without PORT. In patients with R0 disease who have indications for POCT and PORT, POCT is typically delivered prior to PORT (termed “late PORT” in this manuscript) because these patients are thought to likely harbor micrometastatic disease with a relatively low risk of locoregional disease that would cause a LRR. The only subsets of patients where PORT is delivered concurrently with POCT or prior to POCT (termed “early PORT”). In these patients, the burden of local disease is theorized to outweigh the risk of micrometastatic disease; PORT is theorized to minimize further micrometastatic dissemination and prevent LRR. The exact timing of PORT in relationship to POCT has not been investigated in R0 patients

Methods

Results

Conclusion