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ESMO 2020: Is Routine Postoperative Radiotherapy in NSCLC With Mediastinal Nodes of Benefit?

By: Sarah Campen, PharmD
Posted: Tuesday, September 22, 2020

In patients with non–small cell lung cancer (NSCLC) and mediastinal nodal involvement, postoperative radiotherapy after complete resection and neoadjuvant and/or adjuvant chemotherapy do not appear to improve 3-year disease-free survival, according to data from the phase III Lung ART trial. The study findings were presented at the European Society for Medical Oncology (ESMO) Virtual Congress 2020 (Abstract LBA3_PR). “Postoperative radiotherapy cannot be recommended for all patients with stage II and III NSCLC with mediastinal nodal involvement,” explained study author Cécile Le Pechoux, MD, of the Institut Gustave Roussy, Paris, in an ESMO press release. “We need to do further analysis to determine if certain patients could benefit from it.”

From 2007 to 2018, a total of 501 patients with completely resected NSCLC with nodal involvement were randomly assigned after surgery or after chemotherapy to receive postoperative radiotherapy over 5 weeks (n = 252) or to receive no postoperative radiotherapy (n = 249). Most patients received chemotherapy; 77% received adjuvant, and 18% received neoadjuvant chemotherapy.

Disease-free survival at 3 years was not significantly different between the study arms: 47.1% with postoperative radiotherapy versus 43.8% in the control arm (P = 0.16). Median disease-free survival was 30.5 versus 22.8 months, respectively. Overall survival at 3 years was also similar between the groups, at 66.5% in the postoperative-radiotherapy arm compared with 68.5% in the control arm. As for safety, the rates of early and late grade 3 to 5 cardiopulmonary toxicity were higher with postoperative radiotherapy (7% and 20%, respectively) than without it (3.2% and 7.7%).

 Disclosure: For full disclosure of the study authors, visit esmo.org.



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