Postoperative Radiotherapy for Resected Pathological Stage IIIA–N2 Non-Small Cell Lung Cancer: A Retrospective Study of 221 Cases from a Single Institution

Abstract

Abstract Learning Objectives After completing this course, the reader will be able to: Describe the present clinical practice and controversies regarding the use of PORT in resected pIIIA-pN2 NSCLC.Evaluate the effect of PORT on overall survival and on tumor control in this subgroup of patients. CME This article is available for continuing medical education credit at CME.TheOncologist.com Background. For patients with resected pathological stage IIIA–N2 non-small cell lung cancer (NSCLC), the role of postoperative radiotherapy (PORT) is not well defined. In this single-institutional study, we re-evaluated the effect of PORT on overall survival (OS) as well as tumor control in this subgroup of patients. Methods. In 2003–2005, 221 consecutive patients with resected pathological stage IIIA–N2 NSCLC at our institution were retrospectively analyzed in an institutional review board–approved study. The effect of PORT on OS, cancer-specific survival (CSS), and disease-free survival (DFS) was evaluated using the Kaplan–Meier method and log-rank tests. The impact of PORT on locoregional control and distant metastasis was also analyzed. Results. Compared with the control, patients treated with PORT had a significantly longer OS time (χ2, 3.966; p = .046) and DFS interval (χ2, 6.891; p = .009), as well as a trend toward a longer CSS duration (χ2, 3.486; p = .062). Patients treated with PORT also had a significantly higher locoregional recurrence-free survival rate (χ2, 5.048; p = .025) as well as distant metastasis-free survival rate (χ2, 11.248; p = .001). Multivariate analyses showed that PORT was significantly associated with a longer OS duration (p = .000). Conclusions. PORT can significantly improve the survival of patients with resected pathological stage IIIA–N2 NSCLC. A prospective randomized multicenter clinical trial is ongoing.