Abstract
Objectives: The role of postoperative radiotherapy (PORT) in the treatment of patients with completely resected non-small cell lung cancer (NSCLC) is not clear. Few study explored the trends of the PORT use. In this study, we examine the status of PORT use of completely resected NSCLC in mainland China.Methods: From 2005 to 2014, patients with primary lung cancer from eight hospitals across seven geographic regions of mainland China were selected. Then patients with staged I–IIIA NSCLC receiving radical surgery were enrolled in this study. The chi-square test was used to compare differences in the use of PORT among the groups of different age, regions and stages. The Cochran-Armitage trend test was used to identify the trend in the PORT use from 2005 to 2014.Results: Totally, 2,253 out of 7,184 patients were with staged I–IIIA NSCLC receiving completely resection. Only 122 patients (5.42%) received PORT. During this decade, the use of PORT declined significantly (p = 0.0002). In high socio-economic areas, the percentage of PORT use was 7.43%, which was significantly higher than 1.34% in the low socio-economic areas (p < 0.0001). Age was also associated with PORT use (p = 0.0747). For N0-1 and N2 NSCLC, the proportions of PORT use were 4.01 and 10.22%, respectively (p < 0.0001). And in N0-1 or N2 NSCLC, the proportions both decreased significantly during this decade (p = 0.009 and 0.026, respectively). For stage I, IIA, IIB and IIIA, the proportions who received PORT were 2.59, 4.65, 5.49, and 10.29%, respectively (p < 0.0001). Modern radiation techniques were widely used, but the volumes and doses varied widely. The proportions of using IMRT and EPID/IGRT increased after 2012.Conclusions: In China, the use of PORT was less than developed countries and had a declined trend. The use of PORT was related to disease stages, patients' age and geographic location. Both in N0-1 and N2 diseases, the use of PORT declined. Proper education of radiation doctors was urgently needed.
Highlights
Based on 2008 estimates, throughout the world, lung cancer accounts for 13% of the total cases of cancer and 18% of the cancer-related deaths [1]
4,211 patients were pathologically diagnosed as NSCLC
After matching the aforementioned criteria, 2,253 patients with staged I–IIIA NSCLC receiving radical surgery were enrolled in this study
Summary
Based on 2008 estimates, throughout the world, lung cancer accounts for 13% of the total cases of cancer and 18% of the cancer-related deaths [1]. In China, lung cancer remains the most common incident cancer and the leading cause of cancer death [2]. Surgery remains the most important treatment for stage I/II and IIIA NSCLC. Many radiation oncologists remain skeptical about this results because of the toxicities, especially therapy-related deaths caused by suboptimal, outdated irradiation equipment and techniques, and the unacceptable radiation doses [8, 9]. In 2004, chemotherapy became standard of care when the International Adjuvant Lung Cancer Trial (IALT) demonstrated that in comparison to surgery alone, cisplatin-based adjuvant therapy improved survival in patients with resected NSCLC [14]. The role of PORT has remained controversial for decades
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