Predictors of relapse and evaluation of the role of postoperative radiation therapy in a modern series of patients with surgically resected stage III (N2) non–small cell lung cancer

William G. Breen, Kenneth W. Merrell, Aaron Mansfield, Dennis A Wigle, Yolanda Isabel Garces, Sean S Park, Kenneth R. Olivier, Christopher Hallemeier

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Abstract

Purpose For patients with stage III (N2) non–small cell lung cancer (NSCLC) treated with surgical resection, postoperative chemotherapy improves overall survival (OS), but the role of postoperative radiation therapy (PORT) is controversial. The purpose of this study was to evaluate risk factors for local-regional recurrence and to evaluate the impact of PORT on local-regional control (LRC) and OS in a modern series of patients with surgically resected stage III (N2) NSCLC. Methods and materials A retrospective review was performed of patients with Stage III (N2) NSCLC who underwent curative intent resection at our institution between February 1999 and January 2012. OS, LRC, and metastasis-free survival were estimated from the date of surgery using the Kaplan Meier method. Results A total of 71 patients were included in the study. Patient median age was 63 years. Histology was adenocarcinoma in 69% of patients. Pretreatment positron emission tomography/computed tomography staging was performed for 90% of patients, and preoperative chemotherapy was administered in 23%. The rate of R0 resection was 96%. Forty-one patients (58%) received PORT and the median PORT dose was 50 Gy (range, 41.4-60 Gy). The median follow-up time for living patients was 5.0 years. Five-year OS for all patients was 66%. OS at 5 years for patients who received PORT compared with patients who did not receive PORT was 71% versus 60%, respectively (hazard ratio [HR], 0.61; 95% CI, 0.30-1.44; P =.28). LRC at 5 years for patients who received PORT compared with patients who did not receive PORT was 89% versus 76%, respectively (HR, 0.44; 95% CI, 0.13-1.45; P =.17). Factors associated with decreased LRC were male sex (P =.011) and primary tumor (pT) stage (pT3/4 vs. pT1/2, P =.006). Metastasis-free survival at 5 years for patients who received PORT compared with those who did not receive PORT was 62% versus 63%, respectively (HR, 1.07; 95% CI, 0.51-2.40; P =.86). Conclusions In this modern series of patients with resected stage III (N2) NSCLC, patients who received PORT had higher rates of OS and LRC, but these differences were not statistically significant.

Original languageEnglish (US)
Pages (from-to)12-18
Number of pages7
JournalAdvances in Radiation Oncology
Volume2
Issue number1
DOIs
StatePublished - Jan 1 2017

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Non-Small Cell Lung Carcinoma
Radiotherapy
Recurrence
Survival
Neoplasm Metastasis
Drug Therapy
Histology

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{eb19c024b03d41b9a390979a1f68caf6,
title = "Predictors of relapse and evaluation of the role of postoperative radiation therapy in a modern series of patients with surgically resected stage III (N2) non–small cell lung cancer",
abstract = "Purpose For patients with stage III (N2) non–small cell lung cancer (NSCLC) treated with surgical resection, postoperative chemotherapy improves overall survival (OS), but the role of postoperative radiation therapy (PORT) is controversial. The purpose of this study was to evaluate risk factors for local-regional recurrence and to evaluate the impact of PORT on local-regional control (LRC) and OS in a modern series of patients with surgically resected stage III (N2) NSCLC. Methods and materials A retrospective review was performed of patients with Stage III (N2) NSCLC who underwent curative intent resection at our institution between February 1999 and January 2012. OS, LRC, and metastasis-free survival were estimated from the date of surgery using the Kaplan Meier method. Results A total of 71 patients were included in the study. Patient median age was 63 years. Histology was adenocarcinoma in 69{\%} of patients. Pretreatment positron emission tomography/computed tomography staging was performed for 90{\%} of patients, and preoperative chemotherapy was administered in 23{\%}. The rate of R0 resection was 96{\%}. Forty-one patients (58{\%}) received PORT and the median PORT dose was 50 Gy (range, 41.4-60 Gy). The median follow-up time for living patients was 5.0 years. Five-year OS for all patients was 66{\%}. OS at 5 years for patients who received PORT compared with patients who did not receive PORT was 71{\%} versus 60{\%}, respectively (hazard ratio [HR], 0.61; 95{\%} CI, 0.30-1.44; P =.28). LRC at 5 years for patients who received PORT compared with patients who did not receive PORT was 89{\%} versus 76{\%}, respectively (HR, 0.44; 95{\%} CI, 0.13-1.45; P =.17). Factors associated with decreased LRC were male sex (P =.011) and primary tumor (pT) stage (pT3/4 vs. pT1/2, P =.006). Metastasis-free survival at 5 years for patients who received PORT compared with those who did not receive PORT was 62{\%} versus 63{\%}, respectively (HR, 1.07; 95{\%} CI, 0.51-2.40; P =.86). Conclusions In this modern series of patients with resected stage III (N2) NSCLC, patients who received PORT had higher rates of OS and LRC, but these differences were not statistically significant.",
author = "Breen, {William G.} and Merrell, {Kenneth W.} and Aaron Mansfield and Wigle, {Dennis A} and Garces, {Yolanda Isabel} and Park, {Sean S} and Olivier, {Kenneth R.} and Christopher Hallemeier",
year = "2017",
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day = "1",
doi = "10.1016/j.adro.2016.12.004",
language = "English (US)",
volume = "2",
pages = "12--18",
journal = "Advances in Radiation Oncology",
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TY - JOUR

T1 - Predictors of relapse and evaluation of the role of postoperative radiation therapy in a modern series of patients with surgically resected stage III (N2) non–small cell lung cancer

AU - Breen, William G.

AU - Merrell, Kenneth W.

AU - Mansfield, Aaron

AU - Wigle, Dennis A

AU - Garces, Yolanda Isabel

AU - Park, Sean S

AU - Olivier, Kenneth R.

AU - Hallemeier, Christopher

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Purpose For patients with stage III (N2) non–small cell lung cancer (NSCLC) treated with surgical resection, postoperative chemotherapy improves overall survival (OS), but the role of postoperative radiation therapy (PORT) is controversial. The purpose of this study was to evaluate risk factors for local-regional recurrence and to evaluate the impact of PORT on local-regional control (LRC) and OS in a modern series of patients with surgically resected stage III (N2) NSCLC. Methods and materials A retrospective review was performed of patients with Stage III (N2) NSCLC who underwent curative intent resection at our institution between February 1999 and January 2012. OS, LRC, and metastasis-free survival were estimated from the date of surgery using the Kaplan Meier method. Results A total of 71 patients were included in the study. Patient median age was 63 years. Histology was adenocarcinoma in 69% of patients. Pretreatment positron emission tomography/computed tomography staging was performed for 90% of patients, and preoperative chemotherapy was administered in 23%. The rate of R0 resection was 96%. Forty-one patients (58%) received PORT and the median PORT dose was 50 Gy (range, 41.4-60 Gy). The median follow-up time for living patients was 5.0 years. Five-year OS for all patients was 66%. OS at 5 years for patients who received PORT compared with patients who did not receive PORT was 71% versus 60%, respectively (hazard ratio [HR], 0.61; 95% CI, 0.30-1.44; P =.28). LRC at 5 years for patients who received PORT compared with patients who did not receive PORT was 89% versus 76%, respectively (HR, 0.44; 95% CI, 0.13-1.45; P =.17). Factors associated with decreased LRC were male sex (P =.011) and primary tumor (pT) stage (pT3/4 vs. pT1/2, P =.006). Metastasis-free survival at 5 years for patients who received PORT compared with those who did not receive PORT was 62% versus 63%, respectively (HR, 1.07; 95% CI, 0.51-2.40; P =.86). Conclusions In this modern series of patients with resected stage III (N2) NSCLC, patients who received PORT had higher rates of OS and LRC, but these differences were not statistically significant.

AB - Purpose For patients with stage III (N2) non–small cell lung cancer (NSCLC) treated with surgical resection, postoperative chemotherapy improves overall survival (OS), but the role of postoperative radiation therapy (PORT) is controversial. The purpose of this study was to evaluate risk factors for local-regional recurrence and to evaluate the impact of PORT on local-regional control (LRC) and OS in a modern series of patients with surgically resected stage III (N2) NSCLC. Methods and materials A retrospective review was performed of patients with Stage III (N2) NSCLC who underwent curative intent resection at our institution between February 1999 and January 2012. OS, LRC, and metastasis-free survival were estimated from the date of surgery using the Kaplan Meier method. Results A total of 71 patients were included in the study. Patient median age was 63 years. Histology was adenocarcinoma in 69% of patients. Pretreatment positron emission tomography/computed tomography staging was performed for 90% of patients, and preoperative chemotherapy was administered in 23%. The rate of R0 resection was 96%. Forty-one patients (58%) received PORT and the median PORT dose was 50 Gy (range, 41.4-60 Gy). The median follow-up time for living patients was 5.0 years. Five-year OS for all patients was 66%. OS at 5 years for patients who received PORT compared with patients who did not receive PORT was 71% versus 60%, respectively (hazard ratio [HR], 0.61; 95% CI, 0.30-1.44; P =.28). LRC at 5 years for patients who received PORT compared with patients who did not receive PORT was 89% versus 76%, respectively (HR, 0.44; 95% CI, 0.13-1.45; P =.17). Factors associated with decreased LRC were male sex (P =.011) and primary tumor (pT) stage (pT3/4 vs. pT1/2, P =.006). Metastasis-free survival at 5 years for patients who received PORT compared with those who did not receive PORT was 62% versus 63%, respectively (HR, 1.07; 95% CI, 0.51-2.40; P =.86). Conclusions In this modern series of patients with resected stage III (N2) NSCLC, patients who received PORT had higher rates of OS and LRC, but these differences were not statistically significant.

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