Postoperative Radiation Therapy May Improve Overall Survival in Incompletely Resected Stage II or III NSCLC
In a National Cancer Data Base analysis reported in the Journal of Clinical Oncology, Wang et al found that postoperative radiation therapy has been declining in use in recent years but is associated with improved overall survival in patients with incompletely resected stage II or III non–small cell lung cancer (NSCLC).
Study Details
The study included data from patients with pathologic stage N0–2, stage II or III NSCLC who had undergone lobectomy or pneumonectomy with positive surgical margins between 2003 and 2011. Only patients who received external-beam radiation therapy at 50 to 74 Gy or observation were included in the analysis. To adjust for perioperative mortality, the analysis excluded patients who survived less than 4 months after diagnosis.
Overall Survival Benefit
Among 3,395 patients included in the analysis, 1,207 (35.6%) received postoperative radiation therapy, with the proportion receiving radiation therapy decreasing from 42.0% in 2005 to a low of 30.5% in 2010. Factors associated with an increased likelihood of postoperative radiation therapy included age < 60 years, treatment in a nonacademic facility, earlier year of diagnosis, decreased travel distance, lower nodal stage, and use of chemotherapy.
On multivariate analysis adjusting for demographic and clinicopathologic factors, postoperative radiation therapy was associated with significantly better overall survival (hazard ratio = 0.80, P = .002). Radiation therapy was associated with a significant overall survival benefit across nodal stages, with hazard ratios of 0.67 (P = .010) in N0 disease, 0.79 (P = .038) in N1 disease, and 0.73 (P = .020) in N2 disease.
The investigators concluded: "[Postoperative radiation therapy] is associated with improved overall survival in patients with incompletely resected stage II or III N0–2 NSCLC. The use of [postoperative radiation therapy] for this population in more recent years has been declining. In the absence of randomized trials evaluating [postoperative radiation therapy] utilization for this patient population, our findings strongly support the delivery of [postoperative radiation therapy] in patients with incompletely resected NSCLC.”
James Byunghoon Yu, MD, MHS, of Yale School of Medicine, is the corresponding author of the Journal of Clinical Oncology article.
For full disclosures of the study authors, visit jco.ascopubs.org.
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