Oncotarget

Clinical Research Papers:

Efficacy of postoperative radiotherapy in patients with pathological stage N2 epidermal growth factor receptor wild type adenocarcinoma and squamous cell carcinoma lung cancer

Yen-Kuang Lin, Han-Lin Hsu, Wei-Cheng Lin, Jer-Hwa Chang, Yw-Chun Chang, Chia-Lun Chang, Kevin Sheng-Po Yuan, Alexander T.H. Wu and Szu-Yuan Wu _

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Oncotarget. 2017; 8:35280-35288. https://doi.org/10.18632/oncotarget.13257

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Abstract

Yen-Kuang Lin1, Han-Lin Hsu2,3, Wei-Cheng Lin4, Jer-Hwa Chang2,3, Yw-Chun Chang4, Chia-Lun Chang5, Kevin Sheng-Po Yuan6, Alexander T.H. Wu7 and Szu-Yuan Wu8,9,10,11*

1 Biostatistics Center and School of Public Health, Taipei Medical University, Taipei, Taiwan

2 Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

3 School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan

4 Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

5 Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

6 Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

7 Ph.D. Program for Translational Medicine, Taipei Medical University, Taipei, Taiwan

8 Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan

9 Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

10 Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

11 Department of Biotechnology, Hungkuang University, Taichung, Taiwan

Correspondence to:

Szu-Yuan Wu, email:

Keywords: lung cancer, pN2, survival, adjuvant radiotherapy

Received: August 26, 2016 Accepted: October 28, 2016 Published: November 09, 2016

Abstract

Purpose: Few large, prospective, randomized studies have compared the effects of postoperative radiotherapy (PORT) in pathological N2 (pN2) with those of surgical resection alone. in terms of long-term survival in lung adenocarcinoma (adenoCA; wild-type [WT] epidermal growth factor receptor [EGFR]) and squamous cell carcinoma (squCA) settings. This nationwide cohort study clarifies the role of PORT in the survival of pN2 lung adenoCA (WT EGFR) and squCA patients

Patients and Methods: We analyzed data of patients with adenoCA (WT EGFR) and squCA collected from the Taiwan Cancer Registry database. The patients were categorized into five groups according to the treatment modality: Group 1 (surgery alone), Group 2 (adjuvant chemotherapy [CT] alone), Group 3 (adjuvant radiotherapy [RT] alone), Group 4 (adjuvant concurrent chemoradiotherapy [CCRT]), and Group 5 (adjuvant sequential CT and intensity-modulated RT [IMRT]).

Results: We enrolled 588 lung adenoCA (WT EGFR) and squCA patients without distant metastasis. After adjustments for age at surgery, surgical years, and Charlson comorbidity index scores, the multivariate Cox regression analysis demonstrated that adjusted HRs (aHRs; 95% confidence intervals [CIs]) for the overall mortality of female lung adenoCA (WT EGFR) patients were 0.257 (0.111-0.594), 0.530 (0.226-1.243), 0.192 (0.069-0.534), and 0.399 (0.172-0.928) in Groups 2, 3, 4, and 5, respectively. For male lung squCA patients, the aHRs (95% CIs) for overall mortality were 0.269 (0.160-0.451), 0.802 (0.458-1.327), 0.597 (0.358-0.998), and 0.456 (0.265-0.783) in Groups 2, 3, 4, and 5, respectively.

Conclusions: Adjuvant CCRT or sequential CT and IMRT at ≥5000 cGy significantly reduced the mortality rate of female lung adenoCA (WT EGFR) and male squCA pN2 patients.


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