Adjuvant chemotherapy plus radiotherapy is superior to chemotherapy following surgical treatment of stage IIIA N2 non-small-cell lung cancer

Comparison of survival results of patients with T0 and T1-2-3 in pathological T staging in patients with non-small cell lung cancer who underwent surgery after neoadjuvant treatment

Aim

In this study, we aimed to compare the survival results of patients who underwent neoadjuvant treatment with NSCLC between March 1997 and August 2014 and were found to have T0N0 and T1-2-3/N0.

Material and methods

A hundred ninety-five patients who had complete neoadjuvant therapy, complete lung resection and lymph node dissection, and pathologically diagnosed as T0 or T1-2-3/N0, M0 were included in the study.

Results

Of the 195 patients included in the study, 181 were male, 14 were female and the mean age of the patients was 57.9. The mean age of the groups was as follows: group 1: 58.1, group 2: 57.7, group 3: 59.7 and group 4: 56.8. In our series the most common complication was atelectasis (n = 19). Others were prolonged air leak (n = 16), pneumonia (n = 12), apical pleural space (n = 6), wound infection (n = 3), cardiac problems (n = 3), hematoma (n = 3), bronchopleural fistula (n = 3), empyema (n = 2), chylothorax (n = 1). The 5-year survival rate for patients in the T0N0 group was 76.3%. This rate was 71.8% in group 2, 63.6% in group 3 and 44.1% in group 4.

Conclusions

Survival was found to be better in patients who underwent surgery after neoadjuvant therapy and had a complete pathological response. We believe that we can provide better results with the increase in the number of cases detected as TxN0 after the neoadjuvant treatment and prolongation of the follow-up period.

Evaluation of Postoperative Radiotherapy Effect on Survival of Resected Stage III-N2 Non-small Cell Lung Cancer Patients

Objective: The role of postoperative radiotherapy (PORT) in resected stage IIIA-N2 non-small cell lung cancer (NSCLC) patients remains controversial. This study aimed to explore the effect of PORT on survival of resected stage IIIA-N2 NSCLC patients.

Methods: Resected stage IIIA-N2 NSCLC patients aged 18 years or older were identified from the SEER (Surveillance, Epidemiology, and End Results) database from 2010 to 2015. Cox regression analysis was used to identify factors including PORT associated with survival time. A subgroup analysis of patients stratified by number of lymph node metastases was also performed. Overall survival (OS) and overall mortality were compared among the different groups.

Results: A total of 3,445 patients were included in the study. Multivariate Cox analysis showed that PORT had no significant impact on survival of patients with <6 positive lymph node [hazard ratio (HR) = 1.012, P = 0.858, 95% CI: 0.886–1.156]. Postoperative chemotherapy (POCT) (HR = 0.605, P < 0.001, 95% CI: 0.468–0.783) and PORT (HR = 0.724, P = 0.007, 95% CI: 0.574–0.914) are both favorable prognostic factors for stage IIIA-N2 patients with ≥6 positive lymph nodes. In 2,735 patients who featured <6 number of positive regional lymph nodes, patients who received PORT had better survival and lower 3-years and 5-years overall mortality rate than patients who underwent surgery only (41 vs. 28 months, P < 0.015). There was no significant difference in the survival of postoperative patients who underwent POCT in view of whether received PORT (44 vs. 53 months, P = 0.176). A total of 710 patients who featured ≥6 number of positive regional lymph node metastasis were divided into two groups by PORT. PORT did not prolong survival for postoperative patients who did not receive chemotherapy (12 vs. 15 months, P = 0.632). PORT showed a significant advantage in influencing OS in patients who received PORT combined with POCT as compared with those who received POCT only (32 vs. 25 months, P = 0.006).

Conclusions: For IIIA-N2 patients with <6 lymph node metastases, use of PORT can be encouraged to improve survival. For patients with ≥6 positive lymph nodes, PORT combined with POCT significantly improved OS and decreased overall mortality.

Radiotherapy for patients with completely resected pathologic IIIA(N2) non-small-cell lung cancer: a retrospective analysis

Introduction

Adjuvant radiotherapy in non-small-cell lung cancer (NSCLC) remains controversial,Whether the mutation status of epidermal growth factor receptor (EGFR) will affect the recurrence and survival of patients with resected NSCLC is rarely reported. Our purpose is to study the effect of postoperative radiotherapy on patients with stage IIIA(N2) NSCLC with EGFR mutation.

Methods

Total of of 115 patients diagnosed with stage IIIA(N2) resected NSCLC were analyzed retrospectively. Their EGFR mutations were detected by real-time quantitative PCR and DNA sequencing technology together.

Results

At a median follow-up of 34.2 months for the postoperative adjuvant radiotherapy (PORT) group and 31.0 months for the non-PORT group, PORT group significantly improved progression free survival (PFS) and overall survival (OS). The median PFS and OS in the EGFR mutant group were not significantly longer than those in the EGFR wild-type group. The number of chemotherapy cycles, postoperative radiotherapy and the number of metastatic lymph nodes were independent factors influencing long-term survival.

Conclusion

Our retrospective analysis showed that PORT can improve survival of patients with stage IIIA(N2) NSCLC. EGFR-mutant group with stage IIIA(N2) NSCLC has a tendency of a higher survival than the wild-type EGFR group, but there was no significant difference for both groups. The EGFR mutation status was not associated with PFS or OS of stage IIIA(N2) NSCLC.

Five-year survival analysis and prognostic factors in patients operated on for non-small cell lung cancer with N2 disease

Background

The aim of the study is to analyse 5-year survival and prognostic factors in patients operated due to lung cancer with postoperatively confirmed metastases to N2 group nodes.

Methods

In the years 2007-2015, 1,148 patients with lung cancer were treated surgically. A postoperative histopathological study confirmed N2 feature in 150 patients. One hundred and ten patients, in whom a 5-year survival analysis was possible to perform, were included in such analysis. The patients underwent the following procedures: pneumonectomy, 31 patients; lobectomy, 61; bilobectomy, 10; and wedge resection, 8. All patients were subjected to supplementary treatment after the surgery.

Results

Five-year survival was achieved in 23 patients (21%). The patients' survival did not depend on the type of surgery, type of tumour, its location or presence of metastases in N1 nodes (P=0.82, P=0.51, P=0.36 and P=0.23, respectively). A statistically significant correlation was observed (P=0.01) between the 5-year survival of a patient and the occurrence of metastases only in one group of lymph nodes of the N2 feature (22 patients, 20%). Involvement of three or more mediastinal nodal groups resulted in survival shorter than 5-year.

Conclusions

(I) In patients with the N2 feature, the type of performed surgery, type of tumour and the occurrence of metastases in the lymph nodes of the lung hilum do not affect 5-year survival; (II) involvement of only one nodal group allows to achieve 5-year survival in 20% of patients; (III) involvement of three and more nodal groups with the N2 feature results in decreased 5-year survival.

Sequencing postoperative radiotherapy and adjuvant chemotherapy in non-small cell lung cancer: unanswered questions on the not evidence-based approach

This editorial comments on the study by Lee et al. which reported on the use of postoperative radiotherapy (PORT) as first strategy after resection of stage IIIA-pN2 non-small cell lung cancer (NSCLC). After completion of PORT, 41% of patients received postoperative chemotherapy (POCT). The five-year overall survival (OS) was significantly higher in patients treated with PORT and POCT than in patients treated with PORT alone. Authors concluded that PORT used as first postoperative strategy does not compromise a benefit of POCT and its implementation should be further studied. We discuss the pros and cons of using PORT before POCT for stage IIIA-pN2 NSCLC. Some radiobiological data support earlier use of PORT, however, caution should be paid to not to unnecessarily delay or omit POCT because of its demonstrated survival benefit. Concurrent postoperative radio-chemotherapy could be an attractive approach, but we still have very limited clinical data on its use in this indication.