The effect of postoperative radiotherapy on the survival of patients with resectable stage III-N2 non-small-cell lung cancer: a systematic review and meta-analysis.

In the potentially resectable cases of stage III-N2 non-small-cell lung cancer (NSCLC), the optimal post-operative treatment regimen for these patients is uncertain and post-operative radiation therapy (PORT) with chemotherapy is typically recommended. Our aim was to reassess the data of PORT on overall survival (OS) and disease-free survival (DFS) in stage III-N2 NSCLC, in order to figure out whether PORT might lead to a moderate improvement in local control and survival besides resection and adjuvant chemotherapy. A comprehensive search strategy was performed in EMBASE, PubMed, and Cochrane Library for relevant studies comparing PORT combined with adjuvant chemotherapy or adjuvant chemotherapy alone on OS and DFS in resectable stage III-N2 NSCLC. Data were extracted to estimate the effects of PORT on OS and DFS. Eleven studies with 8,928 patients were included. This meta-analysis demonstrated a trend in improving OS associated with the use of PORT (HR=0.88; 95% CI, 0.76 to 1.03; p=0.11) and a significantly difference of effect on DFS associated with the use of PORT (HR=0.78; 95% CI, 0.66 to 0.92; p=0.003). In a subgroup analysis on Caucasian patients, there was a statistically significant benefit (HR=0.88; 95% CI, 0.81 to 0.96; p=0.003) on OS for PORT. Our findings demonstrate that in the postoperative treatment for patients with stage III-N2 NSCLC, PORT is associated with improved OS and leads to a significantly increased DFS.