Benefit of Sequential Chemotherapy Followed by Postoperative Radiotherapy for Patients With Lung Cancer
By: Joseph Fanelli
Posted: Thursday, February 8, 2018
According to a study published in the Journal of Clinical Oncology, patients with non–small cell lung cancer (NSCLC) who undergo R0 resection and have pN2 disease may benefit more from sequential chemotherapy followed by postoperative radiotherapy compared with those who underwent adjuvant concurrent chemoradiotherapy. However, no clear association between treatment sequencing and survival was found in patients with positive margins after surgery.
“Our results contribute to the literature and suggest that when PORT is administered to patients with R0 pN2 disease, there is a survival benefit with sequential C→PORT [chemotherapy followed by postoperative radiotherapy] compared with CRT [concurrent chemoradiotherapy],” according to lead author Samuel Francis, MD, of the University of Utah Huntsman Cancer Institute, and colleagues.
Using the National Cancer Database, the researchers selected two cohorts of patients with nonmetastatic NSCLC. Cohort one included 747 patients with R0 resection and pN2 disease, and cohort two included 277 patients with R1–2 resection regardless of nodal status.
In the first cohort, patients who received chemotherapy followed by postoperative radiotherapy had a median overall survival of 58.8 months, compared with a median overall survival of 40.4 months for those who received concurrent chemoradiotherapy. In cohort two, those who received chemotherapy followed by postoperative radiotherapy had a longer median overall survival than did those who received concurrent radiotherapy (42.6 months vs. 38.5 months). After propensity score matching, sequential chemotherapy remained associated with improved overall survival.