scholarly journals Effectiveness of Postoperative or Preoperative Radiotherapy on Prognosis in Patients with Stage II Resectable Non-Small Cell Lung Cancer: A Retrospective Study Based on the SEER Database

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1202
Author(s):  
Deng Chen ◽  
Jinming Yu
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Independent Risk Factor ◽  
Preoperative Radiotherapy ◽  
Small Cell ◽  
Stage Ii ◽  
Seer Database ◽  
Small Cell Lung ◽  
Cumulative Mortality ◽  
Positive Lymph Nodes

Background and Objectives: The research on the therapeutic effect of preoperative radiotherapy (PRRT) for patients with early non-small cell lung cancer (NSCLC) is still insufficient, and the impact of postoperative radiotherapy (PORT) on the prognosis of patients with early NSCLC remains controversial. We conducted this study to investigate the effect of PORT and PRRT on prognosis for these patients. Materials and Methods: In total, 3640 patients with stage II NSCLC who underwent a lobectomy or pneumonectomy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate regression was adopted to identify the independent influence of PORT or PRRT on patients’ prognosis. Subgroup analysis of survival was performed in patients with different combinations of key clinical features. We also used Kaplan-Meier analysis and competitive risk analysis to explore to which extent PORT or PRRT impacted the overall survival and cumulative mortality. Results: PORT was an independent risk factor of NSCLC-specific death among patients with N0 stage (HR, 1.648; 95% CI, 1.309–2.075, p < 0.001) and in N1 stage with <3 positive lymph nodes (HR, 2.698; 95% CI, 1.910–3.812, p < 0.001) in multivariate analysis. Findings from subgroup analysis for the risk of NSCLC-specific death, competitive risk analysis of NSCLC-specific cumulative mortality, and overall survival analysis also demonstrated PORT was detrimental to patients in these two subgroups above (p < 0.05). However, in patients with N1 stage with ≥3 positive lymph nodes, PORT may help prolong median survival. PRRT was an independent risk factor for NSCLC-specific death in multivariate analysis of patients with N0 stage (HR, 1.790; 95% CI, 1.201–2.668, p = 0.004), and significantly decreased overall survival in these patients (p < 0.001). Conclusion: PORT is associated with worse survival outcome and better cumulative mortality of stage II patients of NSCLC with N0 disease or N1 disease (<3 nodes), while PRRT is associated with reduced prognosis in patients with N0 stage. On the other hand, PORT may help to improve the prognosis of patients with N1 stage who have three or more lymph node metastases. Hence, PORT and PRRT should not be recommended for patients with N0 stage. However, in patients with “high volume” N1 stage, PORT might improve oncological outcomes.

Postoperative Radiation Therapy Is Associated With Improved Overall Survival in Incompletely Resected Stage II and III Non–Small-Cell Lung Cancer

2015 ◽  
Vol 33 (25) ◽  
pp. 2727-2734 ◽  
Author(s):  
Elyn H. Wang ◽  
Christopher D. Corso ◽  
Charles E. Rutter ◽  
Henry S. Park ◽  
Aileen B. Chen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Patient Population ◽  
Small Cell ◽  
Stage Ii ◽  
Small Cell Lung ◽  
Nodal Stage ◽  
Resected Stage

Purpose To review trends in the use of postoperative radiotherapy (PORT) for stage II and III incompletely resected non–small-cell lung cancer (NSCLC) and evaluate the association between PORT and survival in such patients. Patients and Methods We identified patients with pathologic stage N0-2, overall American Joint Committee on Cancer stage II or III NSCLC within the National Cancer Data Base who had undergone a lobectomy or pneumonectomy with positive surgical margins. Only patients coded as receiving external-beam PORT at 50 to 74 Gy or observation were included. To account for perioperative mortality, we excluded patients who survived less than 4 months after diagnosis. Multivariable logistic regression was used to determine factors associated with PORT receipt. Cox proportional hazards regression was performed for multivariable analyses of overall survival. Results Among 3,395 included patients, 1,207 (35.6%) received PORT. Predictors for the use of PORT among this patient population included age less than 60 years, treatment in a nonacademic facility, earlier year of diagnosis, decreased travel distance, lower nodal stage, and chemotherapy receipt. On multivariable analysis adjusting for demographic and clinicopathologic covariates, PORT (hazard ratio, 0.80; 95% CI, 0.70 to 092) was associated with improved survival. Subset analysis by nodal stage showed that PORT improved survival across all nodal stages. Conclusion PORT is associated with improved overall survival in patients with incompletely resected stage II or III N0-2 NSCLC. The use of PORT for this population in more recent years has been declining. In the absence of randomized trials evaluating PORT utilization for this patient population, our findings strongly support the delivery of PORT in patients with incompletely resected NSCLC.

A nomogram for predicting overall survival in resected non-small cell lung cancer with chemotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e21064-e21064
Author(s):  
Yuan Zeng ◽  
Wenhua Liang ◽  
Jianxing He
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Seer Database ◽  
Small Cell Lung ◽  
Lymph Node Count ◽  
Resected Nsclc ◽  
Nsclc Patients

e21064 Background: Chemotherapy is very common for resected Non-Small-Cell Lung Cancer (NSCLC) patients. However, models for predicting the survival outcomes of resected NSCLC patients with chemotherapy are scarce. The aim of this study was to develop a clinical nomogram for predicting overall survival in these patients. Methods: A total of 16661 resected NSCLC with chemotherapy were cases extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We identified and integrated the prognostic factors to build a nomogram.The model was subjected to bootstrap internal validation with the SEER database and external validations with 1108 patients from China. The predictive accuracy and discriminative ability were illustrated by calibration, concordance index (C-index) and risk group stratification. Results: On multivariate analysis independent factors for OS were age, sex, examined lymph node count, extent of surgery, N stage, T stage and grade which were then integrated into the nomogram. The calibration curves for probability of 1-, 3-, and 5-year OS showed excellent agreement between nomogram prediction and actual observation. The C-index of the nomogram was higher than that of AJCC 8th edition system for predicting OS (training cohort, 0.61 vs. 0.58; P < 0.01; validation cohort, 0.66 vs. 0.63, P = 0.56). The stratification into different risk groups allowed significant distinction between survival curves. Conclusions: We established a nomogram that can provide individual prediction of OS for resected NSCLC patients with chemotherapy. This practical prognostic model may help clinicians for treatment planning and to guide future studies.

Phase II Trial of Postoperative Adjuvant Paclitaxel/Carboplatin and Thoracic Radiotherapy in Resected Stage II and IIIA Non–Small-Cell Lung Cancer: Promising Long-Term Results of the Radiation Therapy Oncology Group—RTOG 9705

2005 ◽  
Vol 23 (15) ◽  
pp. 3480-3487 ◽  
Author(s):  
Jeffrey D. Bradley ◽  
Rebecca Paulus ◽  
Mary V. Graham ◽  
David S. Ettinger ◽  
David W. Johnstone ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Small Cell ◽  
Stage Ii ◽  
Oncology Group ◽  
Thoracic Radiotherapy ◽  
Small Cell Lung ◽  
Free Survival

Purpose To determine the overall survival, progression-free survival, and toxicity associated with concurrent paclitaxel/carboplatin and thoracic radiotherapy for completely resected patients with stage II and IIIA non–small-cell lung cancer (NSCLC). Patients and Methods Eighty-eight eligible patients had surgical resection for pathologic stage II or IIIA disease and received postoperative paclitaxel and carboplatin. Concurrent thoracic radiotherapy at 50.4 Gy in 28 fractions for 6 weeks (1.8 Gy/d, 5 days/wk) was given during cycles 1 and 2. A boost of 10.8 Gy in six fractions was given for extracapsular nodal extension or T3 lesions. Results Treatment compliance was acceptable, with 93% compliance for radiation therapy and 86% for chemotherapy completion. The median duration of follow-up was 56.7 months (range, 17 to 61 months). The median overall survival time was 56.3 months, with 1-, 2-, and 3-year survival rates of 86%, 70%, and 61%, respectively. The 1-, 2-, and 3- year progression-free survival rates were 70%, 57%, and 50%, respectively. Brain metastasis occurred as the sole site of first failure in 11%, and 9% failed in other metastatic sites as first failure. Of the 43 patients who died, the cause of death was the treated cancer in 31 (35%). Local failure was a component of first failure in 15% of patients. Toxicities were acceptable. An overall survival comparison to Eastern Cooperative Oncology Group 3590 is favorable. Conclusion The mature results of this trial suggest an improved overall and progression-free survival in this group of resected NSCLC patients, compared with previously reported trials. A phase III trial comparing this treatment regimen with standard therapy seems warranted.

Sign in / Sign up

Export Citation Format

Share Document