The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall cell lung carcinoma with ipsilateral mediastinal lymph node involvement

Timothy E. Sawyer, James A. Bonner, Perry M. Gould, Robert L. Foote, Claude Deschamps, Victor F. Trastek, Peter C. Pairolero, Mark S. Allen, Edward G. Shaw, Randolph Stuart Marks, Stephen Frytak, Carla M. Lange, Hongzhe Li

Research output: Contribution to journalArticle

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Abstract

BACKGROUND. Previous nonsmall cell lung carcinoma studies have shown that patients with ipsilateral mediastinal (N2) lymph node involvement who underwent surgical resection have a greater local recurrence rate than those with less lymph node involvement (NO, N1). Therefore, it was hypothesized that complete surgical clearance of subclinical lymph node disease is difficult in N2 patients and that adjuvant postoperative thoracic radiotherapy (TRT) may be beneficial. METHODS. A retrospective review was performed to determine the local recurrence and survival rates for patients with N2 disease undergoing complete surgical resection with or without adjuvant TRT. Between 1987 and 1993 at the Mayo Clinic, 224 patients underwent complete resection of N2 nonsmall cell lung carcinoma. More than one mediastinal lymph node station was sampled in 98% of patients; 39% then received adjuvant TRT (median dose, 50.4 grays). RESULTS. The median follow- up time was 3.5 years for the patients who were alive at the dine of the analysis. The surgery alone versus surgery plus TRT groups were well balanced with respect to gender, age, histology, tumor grade, number of mediastinal lymph node stations dissected or involved, and involved N1 lymph node number. There were slightly more patients with right lower lobe lesions (compared with other lobes), patients with multiple lobe involvement, and patients with only one N2 lymph node involved in the surgery alone group. After treatment with surgery alone, the actuarial 4-year local recurrence rate was 60%, compared with 17% for treatment with adjuvant TRT (P < 0.0001). The actuarial 4-year survival rate was 22% for treatment with surgery alone, compared with 43% for treatment with adjuvant TRT (P = 0.005). On multivariate analysis, the addition of TRT (P = 0.0001), absence of superior mediastinal lymph node involvement (P = 0.005), and fewer N1 lymph nodes involved (P = 0.02) were independently associated with improved survival rate. CONCLUSIONS. This study, which to the authors' knowledge is the largest evaluating adjuvant TRT in N2 nonsmall cell lung carcinoma, suggests that adjuvant TRT may improve local control and survival.

Original languageEnglish (US)
Pages (from-to)1399-1408
Number of pages10
JournalCancer
Volume80
Issue number8
DOIs
StatePublished - Oct 15 1997

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Adjuvant Radiotherapy
Radiotherapy
Thorax
Lymph Nodes
Carcinoma
Lung
Survival Rate
Recurrence
Patient Rights
Therapeutics
Thoracic Surgery
Histology
Multivariate Analysis
Survival
Neoplasms

Keywords

  • Lung
  • Lymph node
  • Mediastinum
  • Neoplasm
  • Radiation
  • Survival rate
  • Treatment

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall cell lung carcinoma with ipsilateral mediastinal lymph node involvement. / Sawyer, Timothy E.; Bonner, James A.; Gould, Perry M.; Foote, Robert L.; Deschamps, Claude; Trastek, Victor F.; Pairolero, Peter C.; Allen, Mark S.; Shaw, Edward G.; Marks, Randolph Stuart; Frytak, Stephen; Lange, Carla M.; Li, Hongzhe.

In: Cancer, Vol. 80, No. 8, 15.10.1997, p. 1399-1408.

Research output: Contribution to journalArticle

Sawyer, TE, Bonner, JA, Gould, PM, Foote, RL, Deschamps, C, Trastek, VF, Pairolero, PC, Allen, MS, Shaw, EG, Marks, RS, Frytak, S, Lange, CM & Li, H 1997, 'The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall cell lung carcinoma with ipsilateral mediastinal lymph node involvement', Cancer, vol. 80, no. 8, pp. 1399-1408. https://doi.org/10.1002/(SICI)1097-0142(19971015)80:8<1399::AID-CNCR6>3.0.CO;2-A
Sawyer, Timothy E. ; Bonner, James A. ; Gould, Perry M. ; Foote, Robert L. ; Deschamps, Claude ; Trastek, Victor F. ; Pairolero, Peter C. ; Allen, Mark S. ; Shaw, Edward G. ; Marks, Randolph Stuart ; Frytak, Stephen ; Lange, Carla M. ; Li, Hongzhe. / The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall cell lung carcinoma with ipsilateral mediastinal lymph node involvement. In: Cancer. 1997 ; Vol. 80, No. 8. pp. 1399-1408.
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abstract = "BACKGROUND. Previous nonsmall cell lung carcinoma studies have shown that patients with ipsilateral mediastinal (N2) lymph node involvement who underwent surgical resection have a greater local recurrence rate than those with less lymph node involvement (NO, N1). Therefore, it was hypothesized that complete surgical clearance of subclinical lymph node disease is difficult in N2 patients and that adjuvant postoperative thoracic radiotherapy (TRT) may be beneficial. METHODS. A retrospective review was performed to determine the local recurrence and survival rates for patients with N2 disease undergoing complete surgical resection with or without adjuvant TRT. Between 1987 and 1993 at the Mayo Clinic, 224 patients underwent complete resection of N2 nonsmall cell lung carcinoma. More than one mediastinal lymph node station was sampled in 98{\%} of patients; 39{\%} then received adjuvant TRT (median dose, 50.4 grays). RESULTS. The median follow- up time was 3.5 years for the patients who were alive at the dine of the analysis. The surgery alone versus surgery plus TRT groups were well balanced with respect to gender, age, histology, tumor grade, number of mediastinal lymph node stations dissected or involved, and involved N1 lymph node number. There were slightly more patients with right lower lobe lesions (compared with other lobes), patients with multiple lobe involvement, and patients with only one N2 lymph node involved in the surgery alone group. After treatment with surgery alone, the actuarial 4-year local recurrence rate was 60{\%}, compared with 17{\%} for treatment with adjuvant TRT (P < 0.0001). The actuarial 4-year survival rate was 22{\%} for treatment with surgery alone, compared with 43{\%} for treatment with adjuvant TRT (P = 0.005). On multivariate analysis, the addition of TRT (P = 0.0001), absence of superior mediastinal lymph node involvement (P = 0.005), and fewer N1 lymph nodes involved (P = 0.02) were independently associated with improved survival rate. CONCLUSIONS. This study, which to the authors' knowledge is the largest evaluating adjuvant TRT in N2 nonsmall cell lung carcinoma, suggests that adjuvant TRT may improve local control and survival.",
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T1 - The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall cell lung carcinoma with ipsilateral mediastinal lymph node involvement

AU - Sawyer, Timothy E.

AU - Bonner, James A.

AU - Gould, Perry M.

AU - Foote, Robert L.

AU - Deschamps, Claude

AU - Trastek, Victor F.

AU - Pairolero, Peter C.

AU - Allen, Mark S.

AU - Shaw, Edward G.

AU - Marks, Randolph Stuart

AU - Frytak, Stephen

AU - Lange, Carla M.

AU - Li, Hongzhe

PY - 1997/10/15

Y1 - 1997/10/15

N2 - BACKGROUND. Previous nonsmall cell lung carcinoma studies have shown that patients with ipsilateral mediastinal (N2) lymph node involvement who underwent surgical resection have a greater local recurrence rate than those with less lymph node involvement (NO, N1). Therefore, it was hypothesized that complete surgical clearance of subclinical lymph node disease is difficult in N2 patients and that adjuvant postoperative thoracic radiotherapy (TRT) may be beneficial. METHODS. A retrospective review was performed to determine the local recurrence and survival rates for patients with N2 disease undergoing complete surgical resection with or without adjuvant TRT. Between 1987 and 1993 at the Mayo Clinic, 224 patients underwent complete resection of N2 nonsmall cell lung carcinoma. More than one mediastinal lymph node station was sampled in 98% of patients; 39% then received adjuvant TRT (median dose, 50.4 grays). RESULTS. The median follow- up time was 3.5 years for the patients who were alive at the dine of the analysis. The surgery alone versus surgery plus TRT groups were well balanced with respect to gender, age, histology, tumor grade, number of mediastinal lymph node stations dissected or involved, and involved N1 lymph node number. There were slightly more patients with right lower lobe lesions (compared with other lobes), patients with multiple lobe involvement, and patients with only one N2 lymph node involved in the surgery alone group. After treatment with surgery alone, the actuarial 4-year local recurrence rate was 60%, compared with 17% for treatment with adjuvant TRT (P < 0.0001). The actuarial 4-year survival rate was 22% for treatment with surgery alone, compared with 43% for treatment with adjuvant TRT (P = 0.005). On multivariate analysis, the addition of TRT (P = 0.0001), absence of superior mediastinal lymph node involvement (P = 0.005), and fewer N1 lymph nodes involved (P = 0.02) were independently associated with improved survival rate. CONCLUSIONS. This study, which to the authors' knowledge is the largest evaluating adjuvant TRT in N2 nonsmall cell lung carcinoma, suggests that adjuvant TRT may improve local control and survival.

AB - BACKGROUND. Previous nonsmall cell lung carcinoma studies have shown that patients with ipsilateral mediastinal (N2) lymph node involvement who underwent surgical resection have a greater local recurrence rate than those with less lymph node involvement (NO, N1). Therefore, it was hypothesized that complete surgical clearance of subclinical lymph node disease is difficult in N2 patients and that adjuvant postoperative thoracic radiotherapy (TRT) may be beneficial. METHODS. A retrospective review was performed to determine the local recurrence and survival rates for patients with N2 disease undergoing complete surgical resection with or without adjuvant TRT. Between 1987 and 1993 at the Mayo Clinic, 224 patients underwent complete resection of N2 nonsmall cell lung carcinoma. More than one mediastinal lymph node station was sampled in 98% of patients; 39% then received adjuvant TRT (median dose, 50.4 grays). RESULTS. The median follow- up time was 3.5 years for the patients who were alive at the dine of the analysis. The surgery alone versus surgery plus TRT groups were well balanced with respect to gender, age, histology, tumor grade, number of mediastinal lymph node stations dissected or involved, and involved N1 lymph node number. There were slightly more patients with right lower lobe lesions (compared with other lobes), patients with multiple lobe involvement, and patients with only one N2 lymph node involved in the surgery alone group. After treatment with surgery alone, the actuarial 4-year local recurrence rate was 60%, compared with 17% for treatment with adjuvant TRT (P < 0.0001). The actuarial 4-year survival rate was 22% for treatment with surgery alone, compared with 43% for treatment with adjuvant TRT (P = 0.005). On multivariate analysis, the addition of TRT (P = 0.0001), absence of superior mediastinal lymph node involvement (P = 0.005), and fewer N1 lymph nodes involved (P = 0.02) were independently associated with improved survival rate. CONCLUSIONS. This study, which to the authors' knowledge is the largest evaluating adjuvant TRT in N2 nonsmall cell lung carcinoma, suggests that adjuvant TRT may improve local control and survival.

KW - Lung

KW - Lymph node

KW - Mediastinum

KW - Neoplasm

KW - Radiation

KW - Survival rate

KW - Treatment

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