Our analysis shows that in patients with NSCLC classified as N2 nodal disease, OS and PFS could be improved by adding PORT to chemotherapy and administering chemotherapy for more than four cycles. Our analysis shows that in patients with stage IIIA (N2) NSCLC, the OS and PFS can be improved by combining chemotherapy with adjuvant radiotherapy and administering chemotherapy for more than 4 cycles. PORT can improve the survival rate and local relapse-free survival rate in patients with N2-positive multistation lymph nodes. The EGFR mutation status was not associated with long-term survival. Therefore, the efficacy of chemotherapy combined with radiotherapy indicates that this treatment method should be widely used in the clinic. However, due to our small sample size, further evaluations of patients with N2 non-small-cell lung cancer undergoing surgical resection with EGFR mutations are required for clinical research and exploration.

Abbreviation list

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NSCLC, non-small cell lung cancer; PORT, Postoperative radiotherapy; OS, overall survival; EGFR, epidermal growth factor receptor mutation; ROCT, Postoperative chemotherapy; TKI, tyrosine kinase inhibitor; PCR, polymerase chain reaction; CT, computed tomography; MRI, magnetic resonance imaging; WHO, World Health Organization; PS, performance status; CTV, clinical target volume; PTV, planning target volume; FDG-PET/CT, fluorodeoxyglucose positron emission tomography computed tomography.


The authors thank Dong Guo for the support, revision and helpful suggestions.


The authors report no conflicts of interest in this work.

Ying Zhu,1–3,* Lei Fu,2,* Wang Jing,2 Li Kong,2,4 Jinming Yu2,4

1Department of Clinical Medicine, Weifang Medical University, Weifang, Shandong Province, People’s Republic of China; 2Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Jinan, People’s Republic of China; 3Heze Medical College Affiliated Hospital, Heze, Shandong Province, People’s Republic of China; 4Shandong Academy of Medical Sciences, Jinan, Shandong Province, People’s Republic of China

*These authors contributed equally to this work.

Correspondence: Jinming Yu
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, 440 Jinan Road, Jinan 250117, Shandong Province, People’s Republic of China
Tel +86 05 318 798 4777
Fax +86 05 318 798 4079
Email [email protected]


1. Mountain CF. Revisions in the international system for staging lung cancer. Chest. 1997;111(6):1710–1717. doi:10.1378/chest.111.6.1710

2. Goya T, Asamura H, Yoshimura H, et al. Prognosis of 6644 resected non-small cell lung cancers in Japan: a Japanese lung cancer registry study. Lung Cancer. 2005;50(2):227–234. doi:10.1016/j.lungcan.2005.05.021

3. Sawabata N, Miyaoka E, Asamura H, et al. Japanese lung cancer registry study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade. J Thorac Oncol. 2011;6(7):1229–1235. doi:10.1097/JTO.0b013e318219aae2

4. Dillman RO, Seagren SL, Propert KJ, et al. A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. N Engl J Med. 1990;323(14):940–945. doi:10.1056/NEJM199010043231403

5. Dillman RO, Herndon J, Seagren SL, Eaton WL Jr., Green MR. Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst. 1996;88(17):1210–1215. doi:10.1093/jnci/88.17.1210

6. Belani CP, Choy H, Bonomi P, et al. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol. 2005;23(25):5883–5891. doi:10.1200/JCO.2005.55.405

7. Lei T, Xu XL, Chen W, Xu YP, Mao WM. Adjuvant chemotherapy plus radiotherapy is superior to chemotherapy following surgical treatment of stage IIIA N2 non-small-cell lung cancer. Onco Targets Ther. 2016;9:921–928. doi:10.2147/OTT.S95517

8. PORT Meta-analysis Trialists Group. Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. Lancet. 1998;352(9124):257–263.

9. Group PM-aT. Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev. 2005;9(2):CD002142.

10. Burdett S, Rydzewska L, Tierney JF, Fisher DJ, Group PM-aT. A closer look at the effects of postoperative radiotherapy by stage and nodal status: updated results of an individual participant data meta-analysis in non-small-cell lung cancer. Lung Cancer. 2013;80(3):350–352. doi:10.1016/j.lungcan.2013.02.005

11. Douillard JY, Rosell R, De Lena M, et al. Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II, or IIIA non-small-cell lung cancer treated with adjuvant chemotherapy: the adjuvant Navelbine International Trialist Association (ANITA) Randomized Trial. Int J Radiat Oncol Biol Phys. 2008;72(3):695–701. doi:10.1016/j.ijrobp.2008.01.044

12. Robinson CG, Patel AP, Bradley JD, et al. Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy: a review of the National Cancer Data Base. J Clin Oncol. 2015;33(8):870–876. doi:10.1200/JCO.2014.58.5380

13. Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest. 2009;136(1):260–271. doi:10.1378/chest.08-0978

14. Feng W, Zhang Q, Fu XL, et al. The emerging outcome of postoperative radiotherapy for stage IIIA(N2) non-small cell lung cancer patients: based on the three-dimensional conformal radiotherapy technique and institutional standard clinical target volume. BMC Cancer. 2015;15:348. doi:10.1186/s12885-015-1584-3

15. Trodella L, Granone P, Valente S, et al. Adjuvant radiotherapy in non-small cell lung cancer with pathological stage I: definitive results of a phase III randomized trial. Radiother Oncol. 2002;62(1):11–19.

16. Higgins KA, Chino JP, Berry M, et al. Local failure in resected N1 lung cancer: implications for adjuvant therapy. Int J Radiat Oncol Biol Phys. 2012;83(2):727–733. doi:10.1016/j.ijrobp.2011.07.018

17. Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon J-P, Vansteenkiste J. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004;350(4):351–360. doi:10.1056/NEJMoa031644

18. Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005;352(25):2589–2597. doi:10.1056/NEJMoa043623

19. Douillard JY, Rosell R, De Lena M, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol. 2006;7(9):719–727. doi:10.1016/S1470-2045(06)70804-X

20. Zou B, Xu Y, Li T, et al. A multicenter retrospective analysis of survival outcome following postoperative chemoradiotherapy in non-small-cell lung cancer patients with N2 nodal disease. Int J Radiat Oncol Biol Phys. 2010;77(2):321–328. doi:10.1016/j.ijrobp.2009.05.044

21. Lally BE, Zelterman D, Colasanto JM, Haffty BG, Detterbeck FC, Wilson LD. Postoperative radiotherapy for stage II or III non-small-cell lung cancer using the surveillance, epidemiology, and end results database. J Clin Oncol. 2006;24(19):2998–3006. doi:10.1200/JCO.2005.04.6110

22. Mayer R, Smolle-Juettner FM, Szolar D, et al. Postoperative radiotherapy in radically resected non-small cell lung cancer. Chest. 1997;112(4):954–959. doi:10.1378/chest.112.4.954

23. Bekelman JE, Rosenzweig KE, Bach PB, Schrag D. Trends in the use of postoperative radiotherapy for resected non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2006;66(2):492–499. doi:10.1016/j.ijrobp.2006.04.032

24. Corso CD, Rutter CE, Wilson LD, Kim AW, Decker RH, Husain ZA. Re-evaluation of the role of postoperative radiotherapy and the impact of radiation dose for non-small-cell lung cancer using the National Cancer Database. J Thorac Oncol. 2015;10(1):148–155. doi:10.1097/JTO.0000000000000406

25. Koh Y, Jang B, Jeon YK, et al. EGFR gene copy number gain is related to high tumor SUV and frequent relapse after adjuvant chemotherapy in resected lung adenocarcinoma. Jpn J Clin Oncol. 2011;41(4):548–554. doi:10.1093/jjco/hyq248

26. Ragusa M, Vannucci J, Ludovini V, et al. Impact of epidermal growth factor receptor and KRAS mutations on clinical outcome in resected non-small cell lung cancer patients. Am J Clin Oncol. 2014;37(4):343–349. doi:10.1097/COC.0b013e31827a7e7a

Source: Cancer Management and Research.
Originally published December 31, 2019.

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