Early postoperative radiotherapy is associated with improved outcomes over late postoperative radiotherapy in the management of completely resected (R0) Stage IIIA-N2 non-small cell lung cancer
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Huan-Huan Wang1,*, Lei Deng2,*, Qing-Lian Wen3,*, Chun-Ze Zhang4,*, Nicholas G. Zaorsky5, Bai-Lin Zhang1, Jie Chen1, Xian-Liang Zeng1, Yao-Li Cui6, Yang-Yang Shi7, Hai-Ling Hou1, Wei Wang1, Bo Jiang1, Jun Wang1, Qing-Song Pang1, Lu-Jun Zhao1, Zhi-Yong Yuan1, Ping Wang1 and Mao-Bin Meng1
1Department of Radiation Oncology and CyberKnife Center, Tianjin’s Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
2Department of Thoracic Cancer, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
3Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
4Department of Surgery, Nankai University Tianjin People’s Hospital, Tianjin People’s Hospital, Tianjin 300121, China
5Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
6Department of Lymphoma, Tianjin’s Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
7Stanford University School of Medicine, Stanford, CA 94305, USA
*These authors have contributed equally to this work
Mao-Bin Meng, email: [email protected]
Keywords: non-small cell lung cancer, postoperative radiotherapy, postoperative chemotherapy, multimodality therapy, overall survival
Received: December 10, 2016 Accepted: April 24, 2017 Published: May 23, 2017
Aims: The aim of this study was to evaluate the ideal timing of PORT in the management of completely resected (R0) Stage IIIA-N2 NSCLC.
Patients and Methods: Between January 2008 and December 2015, patients with known histologies of pathologic Stage IIIA-N2 NSCLC who underwent R0 resection and received PORT concurrent with or prior to two sequential cycles of chemotherapy (“early PORT”) or with PORT administered after two cycles of chemotherapy (“late PORT”) at multiple hospitals. The primary endpoint was OS; secondary end points included pattern of the first failure, LRRFS, and DMFS. Kaplan–Meier OS, LRRFS, and DMFS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS, LRRFS, and DMFS.
Results: Of 112 included patients, 41 (36.6%) and 71 (63.4%) patients received early PORT and late PORT, respectively. The median OS, LRRFS, and DMFS were longer for those who received early PORT than for those who received late PORT at the median follow-up of 29.6 months (all p < 0.05). Uni- and multi-variate analyses showed that number of POCT cycles and the combination schedule of PORT and POCT were independent prognostic factors for OS, LRRFS, and DMFS.
Conclusions: Early PORT is associated with improved outcomes in pathologic Stage IIIA-N2 R0 NSCLC patients.
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