title: Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy: a review of the National Cancer Data Base.
abstract: OBJECTIVE
  To investigate the impact of modern postoperative radiotherapy (PORT) on overall survival (OS) for patients with N2 non-small-cell lung cancer (NSCLC) treated nationally with surgery and adjuvant chemotherapy.
  
  
  METHODS
  Patients with pathologic N2 NSCLC who underwent complete resection and adjuvant chemotherapy from 2006 to 2010 were identified from the National Cancer Data Base and stratified by use of PORT (≥ 45 Gy). A total of 4,483 patients were identified (PORT, n = 1,850; no PORT, n = 2,633). The impact of patient and treatment variables on OS was explored using Cox regression.
  
  
  RESULTS
  Median follow-up time was 22 months. On univariable analysis, improved OS correlated with younger age, treatment at an academic facility, female sex, urban population, higher income, lower Charlson comorbidity score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT. On multivariable analysis, improved OS remained independently predicted by younger age, female sex, urban population, lower Charlson score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT (hazard ratio, 0.886; 95% CI, 0.798 to 0.988). Use of PORT was associated with an increase in median and 5-year OS compared with no PORT (median OS, 45.2 v 40.7 months, respectively; 5-year OS, 39.3% [95% CI, 35.4% to 43.5%] v 34.8% [95% CI, 31.6% to 38.3%], respectively; P = .014).
  
  
  CONCLUSIONS
  For patients with N2 NSCLC after complete resection and adjuvant chemotherapy, modern PORT seems to confer an additional OS advantage beyond that achieved with adjuvant chemotherapy alone.
authors: All authors: Washington University, St Louis, MO. crobinson@radonc.wustl.edu.
authors: Cliff G
authors: CG
authors: Robinson
authors: All authors: Washington University, St Louis, MO.
authors: Aalok P
authors: AP
authors: Patel
authors: All authors: Washington University, St Louis, MO.
authors: Jeffrey D
authors: JD
authors: Bradley
authors: All authors: Washington University, St Louis, MO.
authors: Todd
authors: T
authors: DeWees
authors: All authors: Washington University, St Louis, MO.
authors: Saiama N
authors: SN
authors: Waqar
authors: All authors: Washington University, St Louis, MO.
authors: Daniel
authors: D
authors: Morgensztern
authors: All authors: Washington University, St Louis, MO.
authors: Maria Q
authors: MQ
authors: Baggstrom
authors: All authors: Washington University, St Louis, MO.
authors: Ramaswamy
authors: R
authors: Govindan
authors: All authors: Washington University, St Louis, MO.
authors: Jennifer M
authors: JM
authors: Bell
authors: All authors: Washington University, St Louis, MO.
authors: Tracey J
authors: TJ
authors: Guthrie
authors: All authors: Washington University, St Louis, MO.
authors: Graham A
authors: GA
authors: Colditz
authors: All authors: Washington University, St Louis, MO.
authors: Traves D
authors: TD
authors: Crabtree
authors: All authors: Washington University, St Louis, MO.
authors: Daniel
authors: D
authors: Kreisel
authors: All authors: Washington University, St Louis, MO.
authors: Alexander S
authors: AS
authors: Krupnick
authors: All authors: Washington University, St Louis, MO.
authors: G Alexander
authors: GA
authors: Patterson
authors: All authors: Washington University, St Louis, MO.
authors: Bryan F
authors: BF
authors: Meyers
authors: All authors: Washington University, St Louis, MO.
authors: Varun
authors: V
authors: Puri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012044:Regression Analysis; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States; D014505:Urban Population