Postoperative radiation therapy improves overall survival in resected NSCLC

Patients with non-small lung cancer (NSCLC) who received postoperative radiation therapy (PORT) lived an average of 4 months longer compared with patients who had the same disease site, tumor histology, and treatment criteria and who did not receive PORT. This research was presented at the 2014 Multidisciplinary Symposium in Thoracic Oncology, held in Chicago, Illinois.

This study reviewed the records of patients with non-small cell lung cancer treated from 2004 to 2006 from the National Cancer Data Base (NCDB), a joint endeavor of the Commission on Cancer of the American College of Surgeons and the American Cancer Society.

The study authors acquired the data for patients who had surgically resected NSCLC with pathologically involved N2 (pN2) lymph nodes, meaning their tumors had spread to the lymph nodes in the center of the chest and who received chemotherapy. The database was further queried to exclude patients with positive margins, incomplete survival data, those who did not receive adjuvant chemotherapy, histology other than NSCLC, and patients treated with Cobalt-60, non-beam radiotherapy, or neoadjuvant radiotherapy. A total of 2,115 patients met all of the study criteria, with 43% receiving PORT and 57% not treated with PORT.

Patients treated with PORT had an improved overall survival of 42 months compared with 38 months for those not treated with PORT (P=.048).

Multivariable analysis revealed that female gender, adenocarcinoma histology, higher income, urban/rural setting vs metropolitan setting, lower T state, 1 to 2 involved lymph nodes vs 3 or more examined and involved lymph nodes, and younger age correlated to better overall survival (P<.05). No direct relation was found between the effects of PORT and the number of involved lymph nodes.

“These results reinforce the value of PORT for non-small cell lung cancer patients with involved mediastinal lymph nodes. Our data indicates that with modern radiotherapy equipment and treatment techniques, PORT can improve survival for these patients,” said lead study author John L. Mikell, MD, chief resident in the Department of Radiation Oncology at Emory University Winship Cancer Institute in Atlanta, Georgia.

“The data in this study, the largest, most recent cohort of patients with involved mediastinal nodes treated with chemotherapy reinforce that PORT should be considered in addition to chemotherapy following resection of non-small cell lung cancer.”

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