Efficacy of postoperative radiotherapy in patients with pathological stage N2 epidermal growth factor receptor wild type adenocarcinoma and squamous cell carcinoma lung cancer.
OBJECTIVE
Few large, prospective, randomized studies have compared the effects of postoperative radiotherapy (PORT) in pathological N2 (pN2) with those of surgical resection alone. in terms of long-term survival in lung adenocarcinoma (adenoCA; wild-type [WT] epidermal growth factor receptor [EGFR]) and squamous cell carcinoma (squCA) settings. This nationwide cohort study clarifies the role of PORT in the survival of pN2 lung adenoCA (WT EGFR) and squCA patientsPatients and Methods: We analyzed data of patients with adenoCA (WT EGFR) and squCA collected from the Taiwan Cancer Registry database. The patients were categorized into five groups according to the treatment modality: Group 1 (surgery alone), Group 2 (adjuvant chemotherapy [CT] alone), Group 3 (adjuvant radiotherapy [RT] alone), Group 4 (adjuvant concurrent chemoradiotherapy [CCRT]), and Group 5 (adjuvant sequential CT and intensity-modulated RT [IMRT]).


RESULTS
We enrolled 588 lung adenoCA (WT EGFR) and squCA patients without distant metastasis. After adjustments for age at surgery, surgical years, and Charlson comorbidity index scores, the multivariate Cox regression analysis demonstrated that adjusted HRs (aHRs; 95% confidence intervals [CIs]) for the overall mortality of female lung adenoCA (WT EGFR) patients were 0.257 (0.111-0.594), 0.530 (0.226-1.243), 0.192 (0.069-0.534), and 0.399 (0.172-0.928) in Groups 2, 3, 4, and 5, respectively. For male lung squCA patients, the aHRs (95% CIs) for overall mortality were 0.269 (0.160-0.451), 0.802 (0.458-1.327), 0.597 (0.358-0.998), and 0.456 (0.265-0.783) in Groups 2, 3, 4, and 5, respectively.


CONCLUSIONS
Adjuvant CCRT or sequential CT and IMRT at ≥5000 cGy significantly reduced the mortality rate of female lung adenoCA (WT EGFR) and male squCA pN2 patients.
Biostatistics Center and School of Public Health, Taipei Medical University, Taipei, Taiwan.
Yen-Kuang
YK
Lin
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.|School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Han-Lin
HL
Hsu
Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Wei-Cheng
WC
Lin
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.|School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Jer-Hwa
JH
Chang
Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Yw-Chun
YC
Chang
Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Chia-Lun
CL
Chang
Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Kevin Sheng-Po
KS
Yuan
Ph.D. Program for Translational Medicine, Taipei Medical University, Taipei, Taiwan.
Alexander T H
ATH
Wu
Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.|Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Department of Biotechnology, Hungkuang University, Taichung, Taiwan.
Szu-Yuan
SY
Wu
D000230:Adenocarcinoma / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated; D016896:Treatment Outcome
C512478:EGFR protein, human; D066246:ErbB Receptors
adjuvant radiotherapy; lung cancer; pN2; survival