ESMO 2020 — Postop conformal RT is not poised to be standard of care in resected NSCLC


  • Michael Simm
  • Oncology Conference reports
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Takeaway

  • The first European study comparing modern postoperative conformal radiotherapy (PORT) to no PORT in completely resected NSCLC found no significant difference in the primary endpoint of 3-year DFS.
  • Although mediastinal relapse was reduced, the procedure “cannot be recommended as standard of care in all completely resected patients with IIIA-N2 NSCLC,” said Cécile Le Péchoux, radiation oncologist from Institut Gustave Roussy, Paris, France, who presented the findings.

Why this matters

  • PORT in patients with NSCLC has been controversial since a meta-analysis in 1998 showed unfavorable outcomes, particularly in stages pN0 and pN1.
  • Further research on stage N2 was called for.
  • Many changes have arisen since then in the management of stage IIIA-N2 NSCLC, including adjuvant chemotherapy.

Study design

  • LungART is a randomized phase 3 trial comparing mediastinal PORT (54 Gy/27-30 fractions) with no PORT in patients from France and the UK with completely resected NSCLC and mediastinal N2 involvement.
  • Chemotherapy was given pre- and/or postoperatively.
  • 42% of patients had unforeseen N2.
  • Funding: Gustave Roussy.

Key results

  • DFS: median 30.5 (PORT) vs 22.8 months.
    • HR, 0.85 (P=.16).
  • 3-year DFS: 47.1% vs 43.8%.
  • Mediastinal relapse was more frequent as first event in controls (46.1% vs 25.0%). 
  • Death—mostly cardiopulmonary—as the first event was more frequent in the intervention group (14.6% vs 5.3%).
  • OS (secondary endpoint): 66.5% with PORT, 68.5% without PORT.

Limitations

  • The results were presented at a conference and have not undergone formal peer review.
  • Clinical trial population.

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