Postoperative Radiotherapy for Resected Stage IIIA–N2 Non-small-cell Lung Cancer: a Review of Outcomes

Full Article

YT Lam, FMY Lim, M Tong, ACK Cheng

Hong Kong J Radiol 2018;21:241-8

DOI: 10.12809/hkjr1816824

Objective: To review the outcomes of postoperative radiotherapy (PORT) using three-dimensional conformal techniques in patients with resected pathological N2 (pN2) non-small-cell lung cancer (NSCLC).
Methods: Consecutive patients who underwent PORT for resected pN2 NSCLC were retrospectively reviewed. Adjuvant chemotherapy was given before PORT. Locoregional and systemic recurrences, disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Factors associated with DFS and OS were determined using the log-rank test.
Results: Eight men and seven women aged 38 to 76 (median, 65) years were included. All had stage IIIA cancer and underwent lobectomy. 12 and three patients had single and multiple mediastinal lymph node station involvement, respectively. The median numbers of resected lymph nodes and lymph node stations were 6 and 4, respectively. Only five patients underwent systematic nodal dissection or sampling. 13 patients underwent adjuvant chemotherapy. The median follow-up period was 31.9 months. Actuarial locoregional control was 100% at 1 year, 92.4% at 2 years, and 82.0% at 3 years. Ten patients had recurrence; all had distant metastases as the first failure event. The median time to recurrence was 12.6 months. DFS was 66.5% at 1 year, 46.5% at 2 years, and 40.0% at 3 years; the median DFS was 14.9 months. OS was 93.5% at 1 year, 66.5% at 2 years, and 51.5% at 3 years; the median OS was 42.4 months. There were nine deaths; eight were cancer-related and one was of unknown cause. Multiple pN2 lymph node station involvement was the only variable that was significant for both DFS and OS. Compared with patients with single pN2 lymph node station involvement, patients with multiple pN2 lymph node station involvement had shorter median DFS (10.9 months vs. 29.2 months, p = 0.008) and median OS (12.1 months vs. 54.1 months, p = 0.003). No patient had grade 3 or above toxicities.
Conclusion: PORT using modern techniques and dose fractionation for patients with resected pN2 NSCLC was well tolerated and resulted in a high locoregional control rate, but the rate of distant metastasis remained high. Patients with multiple pN2 lymph node station involvement had worse survival.


Author affiliation(s):
YT Lam, FMY Lim, ACK Cheng: Department of Oncology, Princess Margaret Hospital, Laichikok, Hong Kong
M Tong: Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong







方法:回顧性分析接受PORT治療已切除的pN2 NSCLC的連續患者。輔助化療在PORT之前進行。使用Kaplan-Meier方法估計局部和全身復發、無病生存(DFS)和總體生存(OS)率。使用對數秩檢驗來確定與DFS和OS相關的因素。
結果:包括8名男性和7名女性,年齡在38至76歲之間(中位數,65歲)。全部患有IIIA期癌症,並進行肺葉切除術。12例和3例患者分別有單個和多個縱隔淋巴結站轉移。切除淋巴結和淋巴結站中位數分別為6和4。只有5例患者進行了系統的淋巴結清掃或取樣。13例患者接受輔助化療。中位隨訪期為31.9個月。精算局部控制率在1年時為100%、2年時為92.4%、3年時為82.0%。10例患者復發;全以遠處轉移為首例失敗事件。中位復發時間為12.6個月。DFS在1年時為66.5%、2年時為46.5%、3年時為40.0%;中位數DFS為14.9個月。OS在1年時為93.5%、2年時為66.5%、3年時為51.5%;中位OS為42.4個月。九名患者死亡;八名是癌症相關的,一名原因未知。多個pN2淋巴結站轉移是影響DFS和OS的唯一的因素。與單個pN2淋巴結站轉移患者相比,多個pN2淋巴結站轉移患者的中位DFS較短(10.9個月對29.2個月,p = 0.008),中位OS也較短(12.1個月對54.1個月,p = 0.003)。沒有患者有3級或以上的毒性。
結論:採用現代技術和劑量分級法的PORT治療已切除pN2 NSCLC的患者耐受性良好,局部控制率高,但遠處轉移率仍然很高。多個pN2淋巴結站轉移患者的生存率較差。