Postoperative Radiotherapy for Locally Advanced NSCLC: Implications for Shifting to Conformal, High-Risk Fields

Bhavana V. Chapman, Matthew S. Ning, Benjamin Farnia, Shane Mesko, Steven H. Lin, Chad Tang, Pamela K. Allen, Zhongxing Liao, Joe Y. Chang, Ritsuko Komaki, Reza J. Mehran, Saumil J. Gandhi, Daniel R. Gomez

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: To examine the effect of radiotherapy field size on survival outcomes and patterns of recurrence in patients treated with postoperative radiotherapy (PORT) for non–small-cell lung cancer (NSCLC). Methods: We retrospectively reviewed the records of 216 patients with T1-4 N1-2 NSCLC following surgery and PORT using whole mediastinum (WM) or high-risk (HR) nodal fields from 1998 to 2015. Survival rates were calculated using the Kaplan-Meier method. Univariate and multivariable analyses were conducted using Cox proportional hazards modeling for outcomes and logistic regression analysis for treatment toxicities. Results: Median follow-up was 28 months (interquartile range [IQR] 13-75 months) and 38 months (IQR 19-73 months) for WM (n = 131) and HR (n = 84) groups, respectively. Overall survival (OS) was not significantly different between groups (median OS: HR 49 vs. WM 32 months; P = .08). There was no difference in progression-free survival (PFS), freedom from locoregional recurrence (LRR), or freedom from distant metastasis (P >. 2 for all). Field size was not associated with OS, PFS, or LRR (P >. 40 for all). LRR rates were 20% for HR and 26% for WM groups (P = .30). There was no significant difference in patterns of initial site of LRR between groups (P >. 1). WM fields (OR 3.73, P = .001) and concurrent chemotherapy (odds ratio 3.62, P = .001) were associated with grade ≥2 toxicity. Conclusions: Locoregional control and survival rates were similar between PORT groups; an improved toxicity profile was observed in the HR group. Results from an ongoing prospective randomized clinical trial will provide further insight into the consequences of HR PORT fields.

Original languageEnglish (US)
Pages (from-to)225-233.e7
JournalClinical Lung Cancer
Volume22
Issue number3
DOIs
StatePublished - May 2021

Keywords

  • Locoregional control
  • Non–small-cell lung cancer
  • PORT
  • Patterns of recurrence
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Fingerprint

Dive into the research topics of 'Postoperative Radiotherapy for Locally Advanced NSCLC: Implications for Shifting to Conformal, High-Risk Fields'. Together they form a unique fingerprint.

Cite this