Charlotte Billiet1, Stéphanie Peeters2, Herbert Decaluwé3, Johan Vansteenkiste4, Jeroen Mebis5, Dirk De Ruysscher6. 1. KU Leuven - University of Leuven, Department of Radiation Oncology, B-3000 Leuven, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium. Electronic address: charlotte.billiet@jessazh.be. 2. KU Leuven - University of Leuven, Department of Radiation Oncology, B-3000 Leuven, Belgium. 3. KU Leuven - University of Leuven, Department of Thoracic Surgery and Leuven Lung Cancer Group, B-3000 Leuven, Belgium. 4. KU Leuven - University of Leuven, Respiratory Oncology Unit (Department of Pneumology) and Leuven Lung Cancer Group, B-3000 Leuven, Belgium. 5. Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium; Department of Medical Oncology, Jessa Hospital, 3500 Hasselt, Belgium. 6. KU Leuven - University of Leuven, Department of Radiation Oncology, B-3000 Leuven, Belgium; Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, GROW, Maastricht, The Netherlands.
Abstract
INTRODUCTION: The role of postoperative radiation therapy (PORT) in patients with completely resected non-small cell lung cancer (NSCLC) with pathologically involved mediastinal lymph nodes (N2) remains unclear. Despite a reduction of local recurrence (LR), its effect on overall survival (OS) remains unproven. Therefore we conducted a review of the current literature. METHODS: To investigate the benefit and safety of modern PORT, we identified published phase III trials for PORT. We investigated modern PORT in low-risk (ypN0/1 and R0) and high-risk (ypN2 and/or R1/2) patients with stage III-N2 NSCLC treated with induction chemotherapy and resection. RESULTS: Seventeen phase III trials using PORT were selected. Of all PORT N2 studies, 4 were eligible for evaluation of LR, all in high-risk patients only. In these high-risk patients receiving PORT, the mean LR rate at 5years was 20.9% (95% CI 16-24). Two trials were suitable to assess LR rates after chemotherapy and surgery without PORT. In these low-risk patients, the mean 5-year LR was 33.1% (95% CI 27-39). No significant difference in non-cancer deaths between PORT vs. non-PORT patients was observed in N2 NSCLC. CONCLUSION: PORT is worth the controversy because data illustrate that PORT may increase the OS. However, prospective randomized trials are needed to verify this. Copyright Â
INTRODUCTION: The role of postoperative radiation therapy (PORT) in patients with completely resected non-small cell lung cancer (NSCLC) with pathologically involved mediastinal lymph nodes (N2) remains unclear. Despite a reduction of local recurrence (LR), its effect on overall survival (OS) remains unproven. Therefore we conducted a review of the current literature. METHODS: To investigate the benefit and safety of modern PORT, we identified published phase III trials for PORT. We investigated modern PORT in low-risk (ypN0/1 and R0) and high-risk (ypN2 and/or R1/2) patients with stage III-N2 NSCLC treated with induction chemotherapy and resection. RESULTS: Seventeen phase III trials using PORT were selected. Of all PORT N2 studies, 4 were eligible for evaluation of LR, all in high-risk patients only. In these high-risk patients receiving PORT, the mean LR rate at 5years was 20.9% (95% CI 16-24). Two trials were suitable to assess LR rates after chemotherapy and surgery without PORT. In these low-risk patients, the mean 5-year LR was 33.1% (95% CI 27-39). No significant difference in non-cancer deaths between PORT vs. non-PORT patients was observed in N2 NSCLC. CONCLUSION: PORT is worth the controversy because data illustrate that PORT may increase the OS. However, prospective randomized trials are needed to verify this. Copyright Â
Authors: Norma E Farrow; Selena J An; Paul J Speicher; David H Harpole; Thomas A D'Amico; Jacob A Klapper; Matthew G Hartwig; Betty C Tong Journal: J Thorac Cardiovasc Surg Date: 2019-11-13 Impact factor: 5.209