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Postoperative radiation extended survival in resected NSCLC
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Postoperative radiotherapy improved survival by approximately 4 months in patients with resected non–small cell lung cancer with pathologically involved N2 lymph nodes who also underwent adjuvant chemotherapy, according to study findings.
“These results reinforce the value of [postoperative radiotherapy] for NSCLC patients with involved mediastinal lymph nodes,” researcher John L. Mikell, MD, chief resident in the department of radiation oncology at Emory University Winship Cancer Institute, said in a press release. “Our data indicates that with modern radiotherapy equipment and treatment techniques, [postoperative radiotherapy] can improve survival for these patients.”
In the retrospective study, researchers searched the National Cancer Database and identified 2,115 patients with resected NSCLC with pathologically involved N2 nodes who were treated between 2004 and 2006. All patients underwent chemotherapy; 918 patients (43%) also underwent postoperative radiotherapy.
The researchers utilized a multivariable Cox proportional hazards model to evaluate factors correlated with OS. They decreased treatment selection bias through inverse probability of treatment weighting (IPTW) using the propensity score. The Kaplan-Meier estimator and the weight log-rank test based on IPTW were used to compare OS between patients treated with postoperative radiotherapy vs. those who did not undergo postoperative radiotherapy.
The researchers found that patients who underwent postoperative radiotherapy achieved a better OS than those who did not, with postoperative radiotherapy treatment associated with a median survival time of 42 months vs. 38 months in the nonpostoperative radiotherapy cohort (
Multivariable and IPTW Cox models found this association to be significant (multivariable model: HR=0.87; 95% CI, 0.78-0.98; IPTW Cox model: HR=0.89; 95% CI, 0.79-1).
Multivariable analysis revealed associations between better OS and the following: female gender, adenocarcinoma histology, financial status (higher income), urban/rural setting vs. metropolitan setting, lower T stage, one to two involved nodes vs. three or more involved lymph nodes, greater number of examined lymph nodes, and younger age (all P<.05). The effects of postoperative radiotherapy did not seem to be influenced by the number of involved lymph nodes.
“The data in this study, the largest, most recent cohort of patients with involved mediastinal nodes treated with chemotherapy reinforce that [postoperative radiotherapy] should be considered in addition to chemotherapy following resection of NSCLC,” Mikell said in the release.
For more information:
Mikell JL. Presented at: The 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology; Oct. 30-Nov. 1, 2014. Chicago.
Disclosure: The researchers report no relevant financial disclosures.