Indications and Parameters Around Postoperative Radiation Therapy for Lung Cancer

Patients with locally advanced resected non–small-cell lung cancer present a high risk of relapse. Although adjuvant platinum–based chemotherapy has become the standard of care, the role of postoperative radiation therapy (PORT) has been controversial for years. In patients with incomplete resection, PORT should be proposed, on the basis of a strong consensus, despite the absence of randomized evidence. In patients with completely resected (R0) non–small-cell lung cancer, a meta-analysis showed poorer outcomes after PORT in the absence of mediastinal involvement (pN0 and pN1). In patients with pN2, the role of PORT was less clear and required further research. The meta-analysis included trials using older radiation techniques and poorer quality of surgery according to today's standards, and selection of patients was not positron emission tomography–based. Newer retrospective and nonrandomized studies and subgroup analyses of randomized trials evaluating adjuvant chemotherapy suggested a survival benefit of PORT in patients with pN2 R0. Two recent randomized trials (Lung ART and PORT-C) evaluating conformal PORT versus no PORT retrieved no disease-free survival advantage for stage IIIA-N2 patients, even if mediastinal relapse was significantly decreased with PORT. PORT had no effect on survival, possibly given the high rate of distant relapse and risk of additional cardiopulmonary toxicity. Ongoing and future analyses are planned in Lung ART to identify patients for whom PORT could be recommended. Incorporation of newer systemic treatments (immune checkpoint inhibitors or targeted therapy in oncogene-addicted patients) is underway in the neoadjuvant and/or adjuvant setting. Better identification of patients at a high risk of disease recurrence, with analysis of circulating tumor DNA, on the basis of the detection of postsurgical minimal (or molecular) residual disease is warranted in future studies.

Neoadjuvant Chemotherapy Reduces Adjuvant Radiation Therapy in Patients with Locally Advanced Cervical Cancer

Background: To investigated whether carboplatin-paclitaxel neoadjuvant chemotherapy (NACT) benefits patients with locally advanced cervical cancer (LACC) through avoiding or delaying postoperative radiation.Methods: Patients with International Federation of Gynecology and Obstetrics (FIGO 2009) stage IB2-IIA2 who received carboplatin-paclitaxel chemotherapy followed by radical surgery (NACT group) or received primary radical surgery (PRS group) between 2007 and 2017 at our hospital were included. Their clinicopathological characteristics, treatments and follow-up data were retrospectively collected and analyzed. The clinical outcomes, including adjuvant radiation, progression-free survival (PFS), and overall survival (OS), were compared between the groups.Results: There were 197 and 217 patients included in the NACT group and PRS group, respectively. The baseline characteristics were significantly different between the groups, with more patients with more advanced tumor stages and larger tumor sizes in the NACT group. Postoperative pathology examination revealed lower incidences of deep stromal invasion in the NACT group than in the PRS group. More importantly, the cumulative postoperative radiation rate was significantly lower in the NACT group (P = 0.041), while the differences in 5-year OS and PFS were not statistically significant between the groups.Conclusions: NACT reduces the pathological risk factors and adjuvant radiation without compromising survival in patients with LACC, which may protect younger patients from radiation-related side effects and subsequently improve the quality of life.