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Can Postoperative Radiotherapy Improve Survival Outcomes in Patients With NSCLC?

By: Julia Fiederlein
Posted: Wednesday, August 4, 2021

According to the phase III PORT-C trial, published in JAMA Oncology, postoperative radiotherapy does not seem to improve disease-free or overall survival outcomes in patients with stage IIIA pathologic N2 non–small cell lung cancer (NSCLC) who underwent complete resection and adjuvant chemotherapy. Jie He, MD, of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and colleagues explained that further studies are needed to identify patients who may benefit from this treatment.

Eligible patients were randomly assigned to undergo postoperative radiotherapy (n = 184) or observation (n = 180). A total dose of 50 Gy of postoperative radiotherapy was administered.

At a median follow-up of 46 months, a total of 230 disease-free survival events were reported. Postoperative radiotherapy did not seem to significantly improve the 3-year disease-free survival rate in the intention-to-treat population (40.5% vs. 32.7%; hazard ratio = 0.84; P = .20); however, a significant improvement was reported in the preplanned exploratory stratified analysis (hazard ratio = 0.75; log-rank P = .04). The 3-year overall survival rate was 78.3% with postoperative radiotherapy and 82.8% with observation (hazard ratio = 1.02; P = .93); the locoregional recurrence–free survival rates were 66.5% and 59.7%, respectively (hazard ratio = 0.71; P = .03).

In the 310 per-protocol patients, postoperative radiotherapy seemed to significantly improve the rate of disease-free survival (42.8% vs. 30.6%; hazard ratio = 0.75; P = .05); however, no significant overall survival benefit was reported in this population (hazard ratio = 0.83; P = .41). The 3-year rate of local recurrence alone was 9.5% with postoperative radiotherapy and 18.3% with observation (Fine-Gray hazard ratio = 0.55; Gray test P = .04). No radiotherapy-related grade 4 or 5 adverse events were reported.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.



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