Sequence of Postoperative Radiotherapy and Chemotherapy in Locally Advanced or Incompletely Resected NSCLC


Key Points

  • Among patients with pN2 disease after R0 resection, receipt of chemotherapy before radiotherapy was associated with improved survival.
  • No significant effect of sequence was observed among patients with postsurgery positive margins.

In a study of National Cancer Database data reported in the Journal of Clinical Oncology, Francis et al found that receipt of adjuvant chemotherapy before vs concurrently with radiotherapy was associated with improved survival in patients with non–small cell lung cancer (NSCLC) found to have pN2 disease after R0 resection. Sequencing of chemotherapy and radiotherapy did not appear to affect survival in patients with positive postsurgery margins.

Study Details

The study involved data from two cohorts of patients with nonmetastatic disease who had received at least a lobectomy followed by multiagent chemotherapy and radiotherapy between 2006 and 2012. Cohort 1 included 747 patients with R0 resection and pN2 disease, and cohort 2 included 277 patients with R1–2 resection regardless of nodal status. Overall survival was analyzed using a propensity score-matched analysis.  

Survival Outcomes

Median follow-up was 32.8 months in cohort 1 and 27.9 months in cohort 2. In cohort 1, median overall survival was 58.8 months among patients who received chemotherapy before radiotherapy vs 40.4 months among patients who received concurrent chemoradiotherapy (P < .001). In cohort 2, median overall survival was 42.6 months vs 38.5 months in the two subgroups (P = .42). After propensity score matching, receipt of adjuvant chemotherapy before radiotherapy remained associated with improved survival vs concurrent chemoradiotherapy in cohort 1 (hazard ratio [HR] = 1.35, P = .019), with the difference in cohort 2 not being significant (HR = 1.35, P = .19).

The investigators concluded, “Patients with NSCLC who undergo R0 resection and are found to have pN2 disease have improved outcomes when adjuvant chemotherapy is administered before, rather than concurrently with, radiotherapy. For patients with positive margins after surgery, there is not a clear association between treatment sequencing and survival.”

Kristine E. Kokeny, MD, of University of Utah Huntsman Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.




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