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Effect of LINAC-based postoperative radiotherapy on local control and survival in patients with non-small cell lung cancer

Published online by Cambridge University Press:  18 January 2017

Sare Cecen*
Affiliation:
Department of Radiation Oncology, Antalya Education and Research Hospital, Antalya, Turkey
Ali A. Yavuz
Affiliation:
Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
Yigit Cecen
Affiliation:
Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
Evrim Duman
Affiliation:
Department of Radiation Oncology, Antalya Education and Research Hospital, Antalya, Turkey
Beyza S. Ozdemir
Affiliation:
Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
Melek G. Aksu
Affiliation:
Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
*
Correspondence to: Sare Cecen, Antalya Egitim ve Arastirma Hastanesi, Radyasyon Onkolojisi Klinigi, Varlik Mh., Kazim Karabekir Caddesi, 07100, Soguksu, Muratpasa, Antalya, Turkey. Tel: +90 530 5546448. Fax: +90 242 2373014. E-mail: dr_sare81@hotmail.com

Abstract

Aim

To perform a retrospective analysis of survival, local–regional control and the effect of prognostic factors in 61 non-small cell lung cancer patients who were treated with postoperative radiotherapy (PORT) by a linear accelerator (LINAC).

Material and methods

A total of 50–66 Gy PORT with a fractional dose of 1·8–2 Gy was administered to 24 patients (24·5%) for surgical margin positivity, 33 patients (54%) for mediastinal lymph node involvement and 13 patients (21·5%) for both mediastinal lymph node involvement and positive surgical margins.

Results

Median follow-up was 17 months, and the median survival and median distant metastasis-free survival were 25 and 19 months, respectively. Local-regional progression was observed in 10 patients (16·4%). Treatment modality (2D/3D) (p=0·021), tumour size >4 cm (p=0·004), surgical margin positivity (p=0·001), and left lung localisation of the tumour (p≤0·05) were the prognostic factors in terms of survival.

Conclusions

A survey of the literature shows that, without PORT, local recurrence or progression rates increase while overall survival rates decrease. In this study, only patients with PORT are studied and the results show that the local progression and overall survival rates are comparable with literature of LINAC-based PORT. In the case of overall survival, 3D treatment shows better results than 2D treatment modality.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

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References

1. Halperin, E C, Perez, C A, Brady, L W. Principles and Practice of Radiation Oncology, Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, USA, 6th edition. 2013: 939–973.Google Scholar
2. Port Meta-Analysis Trialist Group. Postoperative radiotherapy in non small cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised clinical trials. Lancet 1998; 352: 257263.Google Scholar
3. Chung, C K, Stryker, J A, O’Neill, M Jr, DeMuth, W E Jr. Evaluation of adjuvant postoperative radiotherapy for lung cancer. Int J Radiat Oncol Biol Phys 1982; 8: 18771880.Google Scholar
4. Kirsh, M, Sloan, H. Mediastinal metastases in bronchogenic carcinoma: influence of postoperative irradiation, cell type and location. Ann Thorac Surg 1982; 33: 459463.Google Scholar
5. Douillard, J Y, Rosell, R, De Lena, M. Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II or IIIA non-small cell lung cancer treated with adjuvant chemotherapy: The Adjuvant Navelbine International Trialist Association (ANITA) randomized trial. Int J Radiat Oncol Biol Phys 2008; 72: 695701.Google Scholar
6. Lally, B E, Zelterman, D, Colasanto, J M, Haffty, B G, Detterbeck, F C, Wilson, L D. Postoperative radiation therapy for stage II or III non-small cell lung cancer using the surveillance, epidemiology, and end results database. J Clin Oncol 2006; 24: 29983006.CrossRefGoogle ScholarPubMed
7. Le Péchoux, C, Dunant, A, Pignon, J P et al. Need for a new trial to evaluate adjuvant postoperative radiotherapy in non-small cell lung cancer patients with N2 mediastinal involvement. J Clin Oncol 2007; 25: e10e11.Google Scholar
8. Lung Cancer Study Group. Effects of postoperative mediastinal radiation on completely resected Stage II and Stage III epidermoid cancer of the lung. N Engl J Med 1986; 15: 13771381.Google Scholar
9. Medical Research Council Lung Cancer Working Party. The role of postoperative radiotherapy in non-small cell lung cancer: a multicentre randomised trial in patients with pathologically staged T1-2, N1-2, M0 disease. Br J Cancer 1996; 74: 632639.Google Scholar
10. Dai, H, Hui, Z, Ji, W et al. Postoperative radiotherapy for resected pathological stage IIIA-N2 non-small cell lung cancer: a retrospective study of 221 cases from a single institution. Oncologist 2011; 16: 641650.Google Scholar
11. Liu, W S, Zhao, L J, Wang, S et al. Benefits of postoperative radiotherapy in multimodality treatment of resected small-cell lung cancer with lymph node metastasis. Eur J Surg Oncol 2014; 40 (9): 11561162.Google Scholar
12. Corso, C D, Rutter, C E, Wilson, L D, Kim, A W, Decker, R H, Husain, Z A. Re-evaluation of the role of postoperative radiotherapy and the impact of radiation dose for non-small-cell lung cancer using the National Cancer Database. J Thorac Oncol 2015; 10 (1): 148155.Google Scholar
13. Shen, W Y, Ji, J, Zuo, Y S et al. Comparison of efficacy for postoperative chemotherapy and concurrent radiochemotherapy in patients with IIIA-pN2 non-small cell lung cancer: an early closed randomized controlled trial. Radiother Oncol 2014; 110 (1): 120125.Google Scholar
14. Sawyer, T E, Bonner, J A, Gould, P M et al. Effectiveness of postoperative irradiation in stage IIIA non small cell lung cancer according to regression tree analysis of recurrence risks. Ann Thorac Surg 1997; 64: 14021407 discussion 1407–1408.Google Scholar
15. Jazieh, A R, Hussain, M, Howington, J A et al. Prognostic factors in patients with surgically resected stages I and II non-small cell lung cancer. Ann Thorac Surg 2000; 70: 11681171.Google Scholar
16. Caro, J J, Salas, M, Ward, A, Goss, G. Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer 2001; 91: 22142221.3.0.CO;2-P>CrossRefGoogle Scholar
17. Moretti, L, Yu, D S, Chen, H et al. Prognostic factors for resected non-small cell lung cancer with pN2 status: implications for use of postoperative radiotherapy. Oncologist 2009; 14: 11061115.Google Scholar
18. Mantovani, C, Levra, N G, Filippi, A R et al. Postoperative radiotherapy for patients with completely resected pathologic N2 non-small-cell lung cancer: a retrospective analysis. Clin Lung Cancer 2013; 14 (2): 194199.Google Scholar
19. Zou, B, Xu, Y, Li, T et al. A multicenter retrospective analysis of survival outcome following postoperative chemoradiotherapy in non-small-cell lung cancer patients with N2 nodal disease. Int J Radiation Oncology Biol Phys 2010; 77: 321328.Google Scholar
20. Karakoyun-Çelik, O, Yalman, D, Bolukbasi, Y, Cakan, A, Cok, G, Ozkok, S. Postoperative radiotherapy in the management of resected non-small-cell lung carcinoma: 10 years experience in a single institute. Int J Radiation Oncology Biol Phys 2010; 76: 433439.Google Scholar
21. Billiet, C, Decaluwé, H, Peeters, S et al. Modern post-operative radiotherapy for stage III non-small cell lung cancer may improve local control and survival: a meta-analysis. Radiother Oncol 2014; 110 (1): 38.Google Scholar
22. Astudillo, J, Conill, C. Role of postoperative radiation therapy in stage IIIA non-small cell lung cancer. Ann Thorac Surg 1990; 50: 618623.Google Scholar
23. Green, N, Kurohara, S S, George, F W III, Crews, Q E Jr III. Postresection irradiation for primary lung cancer. Radiology 1975; 116: 405407.Google Scholar
24. Choi, N C, Grillo, H C, Gardiello, M, Scannell, J G, Wilkins, E W Jr. Basis for new strategies in postoperative radiotherapy of bronchogenic carcinoma. Int J Radiat Oncol Biol Phys 1980; 6: 3135.Google Scholar
25. Paterson, R, Russell, M H. Clinical trials in malignant disease. IV-Lung cancer. Value of postoperative radiotherapy. Clin Radiol 1962; 13: 141144.Google Scholar
26. Robinson, C G, Patel, A P, Bradley, J D et al. Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy: a review of the National Cancer Database. J Clin Oncol 2015; 33 (8): 870876.Google Scholar
27. Chen, S, Cheng, YL, Li, S T, Ni, Y J, Gu, B. Effect analysis of chemoradiotherapy after operation in patients with stage III A non-small cell lung cancer. Asian Pac J Trop Med 2012; 5 (10): 823827.CrossRefGoogle Scholar
28. Kim, B H, Kim, H J, Wu, H G et al. Role of postoperative radiotherapy after curative resection and adjuvant chemotherapy for patients with pathological stage N2 non-small-cell lung cancer: a propensity score matching analysis. Clin Lung Cancer 2014; 15 (5): 356364.Google Scholar