Release date: 2014-11-07
According to a new study published at the 2014 Chicago Interdisciplinary Symposium on Thoracic Tumors (CMSTO), postoperative radiotherapy (PORT) after non-small cell lung cancer (NSCLC) surgery improves mean overall survival (OS) 4 months, but not related to the number of pathological lymph node involvement. This is another study that has shown that PORT is used for the benefit of advanced disease treatment, and these studies are changing the past view that PORT may be harmful for advanced disease.
John Mikell, MD, director of the Department of Radiation Oncology at Emory University in the United States, said that some early studies examining the benefits of PORT initially observed PORT's damage to overall survival, which was associated with toxicity from radiation therapy using backward radiation machines and techniques.
Therefore, the purpose of this retrospective study was to evaluate the effect of PORT on the diagnosis of mediastinal lymph node involvement in patients with non-small cell lung cancer (NSCLC) using modern radiation therapy and documented use of chemotherapy. It turns out that PORT appears to be associated with improved overall survival, and that this additional benefit outweighs the benefits of chemotherapy. Relevant results have been published at the 2014 Chicago Interdisciplinary Symposium on Thoracic Tumors (CMSTO).
In the study, the researchers used the National Cancer Data Base (NCDB) to identify patients with stage III NSCLC who underwent complete resection of pathologically involved mediastinal lymph nodes, as well as patients who also received chemotherapy. The patient's confirmed NSCLC time period was 2004-2006, which is the most recent cohort in the database, and mature survival data has been obtained.
The researchers excluded patients treated with outdated radiation equipment and excluded patients who received nonbeam radiation or received inadequate or excessive doses of radiation.
A total of approximately 2,100 patients met the criteria for this study, of which 918 received PORT and 1197 did not. 81% of patients also received adjuvant chemotherapy, 9% received neoadjuvant chemotherapy, and 9% of patients were in unknown order, although they did receive chemotherapy as part of the initial protocol.
Median overall survival (OS) benefits 4 months
The median OS was 42 months in the PORT group and 38 months in the PORT group (P=0.048). The 5-year overall survival was 39.8% in the PORT-treated group and 34.7% in the PORT-treated group.
The researchers also attempted to analyze whether the benefits of PORT depended on the number of affected mediastinal lymph nodes, and found that there was no interaction between the PORT benefit and the number of affected mediastinal lymph nodes.
The researchers pointed out that doctors need to keep in mind that patients with stage III NSCLC have a very poor prognosis. Some patients may benefit from OS benefits much better than 4 months, but even if they only benefit from 4 months, they are actually quite significant. Because the overall survival is often calculated on a monthly basis for this type of patient, the benefit of 4 months is of great clinical significance.
Currently, a prospective randomized clinical trial, LungART, is being conducted in Europe to provide a clear answer to the benefits of PORT for NSCLC patients undergoing resection and chemotherapy.
Source: Bio Valley
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