Postoperative radiotherapy boosts OS in N2 NSCLC

  • Gao F & al.
  • J Natl Compr Canc Netw
  • 1 Jun 2020

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Postoperative radiotherapy (PORT) in stage IIIA NSCLC is associated with significantly better OS in patients with N2 disease, especially those with ≥6 positive lymph nodes.
  • However, PORT was associated with significantly higher mortality in patients with N1 disease in this study.  

Why this matters

  • Research on OS with PORT has yielded conflicting results.

Study design

  • 5168 patients with resected stage IIIA NSCLC from the Surveillance, Epidemiology, and End Results database were treated with PORT (n=1711) or not (n=3457).
  • Funding: None disclosed.

Key results

  • No significant difference in OS in N0 disease.
  • Significantly better OS with postoperative chemotherapy (POCT) alone in N2 disease vs POCT+PORT:
    • 56 vs 32 months (P=.0004).
  • Patients with N2 disease and ≥6 positive lymph nodes who received PORT had significantly better OS than those who did not:
    • 31 vs 22 months (P<.0001>
  • These patients also had better OS with POCT+PORT vs POCT alone:
    • 32 vs 25 months (P=.009).
  • PORT was associated with significantly better OS in patients with N2 disease and 
  • 47 vs 41 months (P=.002).
  • Benefit not seen with POCT+PORT.
  • Mortality at 3 and 5 years significantly higher in N1 disease with PORT (P=.005), but significantly lower in N2 disease and ≥6 positive lymph nodes (P=.022).
  • Limitations

    • Retrospective.