Delayed PORT (> 10 wk) with sequential chemotherapy was associated with improved survival in patients with NSCLC and pN2 nodes.
Karna Sura, MD, Inga S. Grills, MD, Charles C. Vu, MD, Craig W. Stevens, MD, PhD, Hong Ye, MS, Thomas M. Guerrero, MD, PhD; Beaumont Health System
INTRODUCTION: Multiple studies of the National Cancer Data Base (NCDB) have illustrated improved survival with postoperative radiation therapy (PORT) in non–small-cell lung cancer (NSCLC) in incompletely resected stage II and III and margin-negative pathologic N2 disease. Currently, the ideal timing for PORT and chemotherapy is unknown. This study evaluates the impact of PORT and chemotherapy timing on overall survival (OS) using the NCDB.
METHODS: The NCDB was queried for patients from 2004–2012 with resected NSCLC, pathologically involved N2 (pN2) nodes, and negative margins. All patients underwent adjuvant chemotherapy and external beam radiation. Time between surgery and radiation was determined from the date of surgery to the start of radiation, with exclusion of cases less than 2 weeks or greater than 52 weeks postoperatively. OS was determined from date of diagnosis, as well as date of RT completion. Multivariate logistic analysis was used to assess factors associated with treatment delay.
RESULTS: A total of 1,970 patients were eligible for the analysis; 957 patients received PORT < 10 weeks postoperatively, and 1,013 patients received PORT > 10 weeks postoperatively. PORT after 10 weeks was associated with better OS (median survival since diagnosis: 45.9 mo after 10 wk vs 38.0 mo before 10 wk, P < .001; and median survival since completion of RT: 39.2 mo vs 33.8 mo, P = .043). When stratified by concurrent vs sequential chemotherapy, there was no significant difference in survival in the concurrent group. However, there was a significant OS benefit to sequential chemotherapy with delayed radiation (median survival since diagnosis: 48 mo after 10 wk vs 36.9 mo before 10 wk; P = .001). Race, year of diagnosis, number of examined nodes, higher income, and sequential chemotherapy were significantly associated with changes in treatment time.
CONCLUSION: Delayed PORT (> 10 wk) with sequential chemotherapy was associated with improved survival in patients with NSCLC and pN2 nodes.
Proceedings of the 98th Annual Meeting of the American Radium Society -americanradiumsociety.org