Real World Practice of Postoperative Radiotherapy for Completely Resected pIIIA-N2 Non-Small Cell Lung Cancer

Abstract

<h3>Purpose/Objective(s)</h3> Two recently published clinical trials, the PORT-C and Lung ART, revealed that postoperative radiotherapy (PORT) cannot routinely be recommended for all patients with completely resected pIIIA-N2 non-small cell lung cancer (NSCLC). However, the real word decisions regarding PORT that physicians actually make is still unknown. This study was conducted to assess clinical decisions among radiation oncologists and factors influencing implementation of PORT for completely resected pIIIA-N2 NSCLC. <h3>Materials/Methods</h3> A 40-question survey was sent to radiation oncologists from 179 hospitals in China. Questions addressed demographics, the decision change of PORT from before to after the publishing of the two clinical trials, patient-related factors, operation-related factors, lymph nodes-related factors, systemic therapy-related factors, and radiotherapy-related factors influencing the implementation of PORT in completely resected pIIIA-N2 NSCLC. <h3>Results</h3> This research gathered 312 valid questionnaires. The median age of responders was 42 [IQR 38, 49]. Sixty-eight percentage of responders had more than 10 years practicing radiotherapy for treating lung cancers. Before the publishing of the PORT-C and Lung ART studies, PORT was routinely recommended and not recommended in 68.0% and 2.6% of responders, respectively, and 29.5% of responders made decision according to individual risk factors. After the two studies published, the proportion of responders routinely recommending PORT was decreased to 18.0%, however, only 9.6% of responders did not routinely recommend PORT while 72.4% of responders made decisions according to individual risk factors. The five most commonly considered risk factors that responders chose were as follows: the existence of tumor capsular invasion (81.1%), the existence of highest lymph node station metastasis (68.9%), the number of dissected lymph node stations (57.4%), the number of positive lymph nodes (45.5%), the choice of operation methods (43.9%). For the number of dissected lymph node stations, the proportions of responders reported ≤3, ≤2, ≤1, and not a consideration for recommending PORT were 38.5%, 41.0%, 9.3%, and 11.2%, respectively. For the number of positive lymph node stations except for hilar lymph nodes, the proportions of responders reported ≥3, ≥2, ≥1, and not a consideration for recommending PORT were 18.3%, 61.2%, 9.0%, and 11.5%, respectively. The proportions of operation methods chosen (multiple selection) for recommending PORT were as follows: pneumonectomy (2.9%), lobectomy (26.9%), sleeve lobectomy (54.8%), and not a consideration (47.4%). <h3>Conclusion</h3> After the publish of the PORT-C and Lung ART studies, most radiation oncologists made the clinical decisions according to individual risk factors other than not routinely recommending PORT for patients with completely resected pIIIA-N2 NSCLC. Additional studies are required to establish guidelines for use of PORT based on individual risk factors.