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J Korean Soc Ther Radiol Oncol > Volume 29(1); 2011 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2011;29(1): 44-52. doi: https://doi.org/10.3857/jkstro.2011.29.1.44
Role of Postoperative Radiotherapy for Patients with Pathological Stage III Non-Small-Cell Lung Cancer after Curative Resection
Mi Young Kim, Hong Gyun Wu, Hak Jae Kim, Dae Seog Heo, Young Whan Kim, Dong Wan Kim, Se Hoon Lee, Joo Hyun Kim, Young Tae Kim, Chang Hyun Kang
1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. wuhg@snu.ac.kr
2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
3Department of Thoracic Surgery, Seoul National University College of Medicine, Seoul, Korea.
4Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
5Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
To evaluate the outcomes and prognostic factors of postoperative radiotherapy (PORT) for patients with pathological stage III non-small-cell lung cancer (NSCLC) at a single institution.
From 2000 to 2007, 88 patients diagnosed as having pathologic stage III NSCLC after curative resection were treated with PORT. There were 80 patients with pathologic stage IIIA and eight patients with pathologic stage IIIB in the AJCC 6th staging system. The majority of patients (n=83) had pathologic N2 disease, and 56 patients had single station mediastinal LN metastasis. PORT was administered using conventional technique (n=76) or three-dimensional conformal technique (n=12). The median radiation dose was 54 Gy (range, 30.6 to 63 Gy). Thirty-six patients received chemotherapy. Radiation pneumonitis was graded by the Radiation Therapy Oncology Group system, and other treatment-related toxicities were assessed by CTCAE v 3.0.
Median survival was 54 months (range, 26 to 77 months). The 5-year overall survival (OS) and disease free survival (DFS) rates were 45% and 38%, respectively. The number of metastatic lymph nodes was associated with overall survival (hazard ratio, 1.037; p-value=0.040). The 5-year locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS) rates were 88% and 48%, respectively. Multiple stations of mediastinal lymph node metastasis was associated with decreased DFS and DMFS rates (p-value=0.0014 and 0.0044, respectively). Fifty-one relapses occurred at the following sites: 10 loco-regional, 41 distant metastasis. Grade 2 radiation pneumonitis was seen in three patients, and symptoms were well tolerated with anti-tussive medication. Grade 2 radiation esophagitis was seen in 11 patients. There were no grade 3 or more severe complications associated with PORT.
Our retrospective data show that PORT for pathological stage III NSCLC is a safe and feasible treatment and could improve loco-regional control. The number of metastatic lymph nodes and stations of mediastinal lymph node metastasis were analyzed as prognostic factors. Furthermore, efforts are needed to reduce distant metastasis, which is a major failure pattern of advanced stage NSCLC.
Key Words: Post-operative radiotherapy, Pathological stage III non-small cell lung cancer
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