Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy

A review of the national cancer data base

Cliff G. Robinson, Aalok P. Patel, Jeffrey D. Bradley, Todd DeWees, Saiama N. Waqar, Daniel Morgensztern, Maria Q. Baggstrom, Ramaswamy Govindan, Jennifer M. Bell, Tracey J. Guthrie, Graham A. Colditz, Traves D. Crabtree, Daniel Kreisel, Alexander S. Krupnick, G. Alexander Patterson, Bryan F. Meyers, Varun Puri

Research output: Contribution to journalArticle

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Abstract

Purpose To investigate the impact of modern postoperative radiotherapy (PORT) on overall survival (OS) for patients with N2 non-small-cell lung cancer (NSCLC) treated nationally with surgery and adjuvant chemotherapy. Patients and Methods Patients with pathologic N2 NSCLC who underwent complete resection and adjuvant chemotherapy from 2006 to 2010 were identified from the National Cancer Data Base and stratified by use of PORT (≥ 45 Gy). A total of 4,483 patients were identified (PORT, n = 1,850; no PORT, n =2,633). The impact of patient and treatment variables on OS was explored using Cox regression. Results Median follow-up time was 22 months. On univariable analysis, improved OS correlated with younger age, treatment at an academic facility, female sex, urban population, higher income, lower Charlson comorbidity score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT. On multivariable analysis, improved OS remained independently predicted by younger age, female sex, urban population, lower Charlson score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT (hazard ratio, 0.886; 95% CI, 0.798 to 0.988). Use of PORT was associated with an increase in median and 5-year OS compared with no PORT (median OS, 45.2 v 40.7 months, respectively; 5-year OS, 39.3% [95% CI, 35.4% to 43.5%] v 34.8% [95% CI, 31.6% to 38.3%], respectively; P = .014). Conclusion For patients with N2 NSCLC after complete resection and adjuvant chemotherapy, modern PORT seems to confer an additional OS advantage beyond that achieved with adjuvant chemotherapy alone.

Original languageEnglish (US)
Pages (from-to)870-876
Number of pages7
JournalJournal of Clinical Oncology
Volume33
Issue number8
DOIs
StatePublished - Mar 10 2015
Externally publishedYes

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Adjuvant Chemotherapy
Non-Small Cell Lung Carcinoma
Radiotherapy
Databases
Survival
Neoplasms
Urban Population
Drug Therapy
Comorbidity
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy : A review of the national cancer data base. / Robinson, Cliff G.; Patel, Aalok P.; Bradley, Jeffrey D.; DeWees, Todd; Waqar, Saiama N.; Morgensztern, Daniel; Baggstrom, Maria Q.; Govindan, Ramaswamy; Bell, Jennifer M.; Guthrie, Tracey J.; Colditz, Graham A.; Crabtree, Traves D.; Kreisel, Daniel; Krupnick, Alexander S.; Patterson, G. Alexander; Meyers, Bryan F.; Puri, Varun.

In: Journal of Clinical Oncology, Vol. 33, No. 8, 10.03.2015, p. 870-876.

Research output: Contribution to journalArticle

Robinson, CG, Patel, AP, Bradley, JD, DeWees, T, Waqar, SN, Morgensztern, D, Baggstrom, MQ, Govindan, R, Bell, JM, Guthrie, TJ, Colditz, GA, Crabtree, TD, Kreisel, D, Krupnick, AS, Patterson, GA, Meyers, BF & Puri, V 2015, 'Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy: A review of the national cancer data base', Journal of Clinical Oncology, vol. 33, no. 8, pp. 870-876. https://doi.org/10.1200/JCO.2014.58.5380
Robinson, Cliff G. ; Patel, Aalok P. ; Bradley, Jeffrey D. ; DeWees, Todd ; Waqar, Saiama N. ; Morgensztern, Daniel ; Baggstrom, Maria Q. ; Govindan, Ramaswamy ; Bell, Jennifer M. ; Guthrie, Tracey J. ; Colditz, Graham A. ; Crabtree, Traves D. ; Kreisel, Daniel ; Krupnick, Alexander S. ; Patterson, G. Alexander ; Meyers, Bryan F. ; Puri, Varun. / Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy : A review of the national cancer data base. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 8. pp. 870-876.
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title = "Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy: A review of the national cancer data base",
abstract = "Purpose To investigate the impact of modern postoperative radiotherapy (PORT) on overall survival (OS) for patients with N2 non-small-cell lung cancer (NSCLC) treated nationally with surgery and adjuvant chemotherapy. Patients and Methods Patients with pathologic N2 NSCLC who underwent complete resection and adjuvant chemotherapy from 2006 to 2010 were identified from the National Cancer Data Base and stratified by use of PORT (≥ 45 Gy). A total of 4,483 patients were identified (PORT, n = 1,850; no PORT, n =2,633). The impact of patient and treatment variables on OS was explored using Cox regression. Results Median follow-up time was 22 months. On univariable analysis, improved OS correlated with younger age, treatment at an academic facility, female sex, urban population, higher income, lower Charlson comorbidity score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT. On multivariable analysis, improved OS remained independently predicted by younger age, female sex, urban population, lower Charlson score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT (hazard ratio, 0.886; 95{\%} CI, 0.798 to 0.988). Use of PORT was associated with an increase in median and 5-year OS compared with no PORT (median OS, 45.2 v 40.7 months, respectively; 5-year OS, 39.3{\%} [95{\%} CI, 35.4{\%} to 43.5{\%}] v 34.8{\%} [95{\%} CI, 31.6{\%} to 38.3{\%}], respectively; P = .014). Conclusion For patients with N2 NSCLC after complete resection and adjuvant chemotherapy, modern PORT seems to confer an additional OS advantage beyond that achieved with adjuvant chemotherapy alone.",
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T1 - Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy

T2 - A review of the national cancer data base

AU - Robinson, Cliff G.

AU - Patel, Aalok P.

AU - Bradley, Jeffrey D.

AU - DeWees, Todd

AU - Waqar, Saiama N.

AU - Morgensztern, Daniel

AU - Baggstrom, Maria Q.

AU - Govindan, Ramaswamy

AU - Bell, Jennifer M.

AU - Guthrie, Tracey J.

AU - Colditz, Graham A.

AU - Crabtree, Traves D.

AU - Kreisel, Daniel

AU - Krupnick, Alexander S.

AU - Patterson, G. Alexander

AU - Meyers, Bryan F.

AU - Puri, Varun

PY - 2015/3/10

Y1 - 2015/3/10

N2 - Purpose To investigate the impact of modern postoperative radiotherapy (PORT) on overall survival (OS) for patients with N2 non-small-cell lung cancer (NSCLC) treated nationally with surgery and adjuvant chemotherapy. Patients and Methods Patients with pathologic N2 NSCLC who underwent complete resection and adjuvant chemotherapy from 2006 to 2010 were identified from the National Cancer Data Base and stratified by use of PORT (≥ 45 Gy). A total of 4,483 patients were identified (PORT, n = 1,850; no PORT, n =2,633). The impact of patient and treatment variables on OS was explored using Cox regression. Results Median follow-up time was 22 months. On univariable analysis, improved OS correlated with younger age, treatment at an academic facility, female sex, urban population, higher income, lower Charlson comorbidity score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT. On multivariable analysis, improved OS remained independently predicted by younger age, female sex, urban population, lower Charlson score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT (hazard ratio, 0.886; 95% CI, 0.798 to 0.988). Use of PORT was associated with an increase in median and 5-year OS compared with no PORT (median OS, 45.2 v 40.7 months, respectively; 5-year OS, 39.3% [95% CI, 35.4% to 43.5%] v 34.8% [95% CI, 31.6% to 38.3%], respectively; P = .014). Conclusion For patients with N2 NSCLC after complete resection and adjuvant chemotherapy, modern PORT seems to confer an additional OS advantage beyond that achieved with adjuvant chemotherapy alone.

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