Early postoperative radiotherapy is associated with improved outcomes over late postoperative radiotherapy in the management of completely resected (R0) Stage IIIA-N2 nonsmall cell lung cancer

// Huan-Huan Wang 1, * , Lei Deng 2, * , Qing-Lian Wen 3, * , Chun-Ze Zhang 4, * , Nicholas G. Zaorsky 5 , Bai-Lin Zhang 1 , Jie Chen 1 , Xian-Liang Zeng 1 , Yao-Li Cui 6 , Yang-Yang Shi 7 , Hai-Ling Hou 1 , Wei Wang 1 , Bo Jiang 1 , Jun Wang 1 , Qing-Song Pang 1 , Lu-Jun Zhao 1 , Zhi-Yong Yuan 1 , Ping Wang 1 and Mao-Bin Meng 1 1 Department of Radiation Oncology and CyberKnife Center, Tianjin’s Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China 2 Department of Thoracic Cancer, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China 3 Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China 4 Department of Surgery, Nankai University Tianjin People’s Hospital, Tianjin People’s Hospital, Tianjin 300121, China 5 Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA 6 Department of Lymphoma, Tianjin’s Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China 7 Stanford University School of Medicine, Stanford, CA 94305, USA * These authors have contributed equally to this work Correspondence to: Mao-Bin Meng, email: doctormm991@hotmail.com Keywords: non-small cell lung cancer, postoperative radiotherapy, postoperative chemotherapy, multimodality therapy, overall survival Received: December 10, 2016     Accepted: April 24, 2017     Published: May 23, 2017 ABSTRACT Aims: The aim of this study was to evaluate the ideal timing of PORT in the management of completely resected (R0) Stage IIIA-N2 NSCLC. Patients and Methods: Between January 2008 and December 2015, patients with known histologies of pathologic Stage IIIA-N2 NSCLC who underwent R0 resection and received PORT concurrent with or prior to two sequential cycles of chemotherapy (“early PORT”) or with PORT administered after two cycles of chemotherapy (“late PORT”) at multiple hospitals. The primary endpoint was OS; secondary end points included pattern of the first failure, LRRFS, and DMFS. Kaplan–Meier OS, LRRFS, and DMFS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS, LRRFS, and DMFS. Results: Of 112 included patients, 41 (36.6%) and 71 (63.4%) patients received early PORT and late PORT, respectively. The median OS, LRRFS, and DMFS were longer for those who received early PORT than for those who received late PORT at the median follow-up of 29.6 months (all p < 0.05). Uni- and multi-variate analyses showed that number of POCT cycles and the combination schedule of PORT and POCT were independent prognostic factors for OS, LRRFS, and DMFS. Conclusions: Early PORT is associated with improved outcomes in pathologic Stage IIIA-N2 R0 NSCLC patients.