Radiotherapy-first strategy after surgery with or without adjuvant chemotherapy in stage IIIA-N2 non-small cell lung cancer
Menée à partir de données portant sur 105 patients atteints d'un cancer du poumon non à petites cellules de stade IIIA-N2 traité entre 2002 et 2014 (durée médiane de suivi : 30 mois), cette étude évalue, du point de vue de la survie globale à 5 ans, l'efficacité d'une radiothérapie postopératoire suivie ou non d'une chimiothérapie par sels de platine, puis identifie les facteurs cliniques affectant la survie
Purpose : Postoperative radiotherapy (PORT) and postoperative chemotherapy (POCT) can be administered as adjuvant therapies in patients with non-small cell lung cancer (NSCLC). The aim of this study was to present the clinical outcomes of patients treated with PORT-first with or without subsequent POCT in stage IIIA-N2 NSCLC. Materials and methods : From January 2002 to November 2014, 105 patients with stage IIIA-N2 NSCLC who received PORT-first with or without subsequent POCT were analyzed. PORT was initiated within four to six weeks after surgical resection. Platinum-based POCT was administered three to four weeks after the completion of PORT. We analyzed the outcomes and clinical factors affecting survival. Results : Of 105 patients, 43 (41.0%) received POCT with a median of four cycles (range, 2–6). The follow-up time ranged from 3 to 123 months (median, 30), and the five-year overall survival (OS) was 40.2%. The five-year OS of patients treated with PORT and POCT was significantly higher than that of patients with PORT (61.3% vs. 29.2%, p < 0.001). The significant prognostic factors affecting OS were the use of POCT (HR = 0.453, p = 0.036) and type of surgery (pneumonectomy/lobectomy; HR = 2.845, p < 0.001). Conclusions : PORT-first strategy after surgery appeared not to compromise the clinical outcomes in the treatment of stage IIIA-N2 NSCLC. The benefit of POCT on OS was preserved even in the PORT-first setting. Further studies are warranted to compare the sequencing of PORT and POCT, guaranteeing the proper use of POCT.