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Adjuvant chemotherapy plus radiotherapy is superior to chemotherapy following surgical treatment of stage IIIA N2 non-small-cell lung cancer

Authors Lei T, Xu X, Chen W, Xu Y, Mao W

Received 1 September 2015

Accepted for publication 29 December 2015

Published 24 February 2016 Volume 2016:9 Pages 921—928

DOI https://doi.org/10.2147/OTT.S95517

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Ram Prasad

Peer reviewer comments 2

Editor who approved publication: Professor Daniele Santini


Tao Lei,1,* Xiao-Ling Xu,1,* Wei Chen,2 Ya-Ping Xu,3 Wei-Min Mao2

1Department of Medical Oncology, Zhejiang Cancer Hospital, 2Key Laboratory of Diagnosis and Treatment Technology for Thoracic Cancer, Zhejiang Cancer Research Institute, 3Department of Radiotherapy, Zhejiang Province Cancer Hospital, Zhejiang Cancer Center, Hangzhou, People’s Republic of China

*These authors contributed equally to this work

Abstract: The use of additional radiotherapy for resected stage IIIA N2 non-small-cell lung cancer in the setting of standard adjuvant chemotherapy remains controversial. A comprehensive search (last search updated in March 2015) for relevant studies comparing patients with stage IIIA N2 non-small-cell lung cancer undergoing resection after treatment with adjuvant postoperative chemotherapy alone or adjuvant postoperative chemoradiotherapy (POCRT) was conducted. Hazard ratios (HRs) were extracted from these studies to give pooled estimates of the effects of POCRT on overall survival (OS) and disease-free survival (DFS). Six studies were included. The meta-analysis demonstrated that POCRT had a greater OS benefit than postoperative chemotherapy (HR =0.87, 95% confidence interval [CI]: 0.79–0.96, P=0.006). Unfortunately, there was no significant difference in DFS between the two groups: the combined HR for DFS was 0.91 (95% CI: 0.57–1.46, P=0.706). In a subgroup analysis of two randomized controlled trials (n=172 patients), adding radiation was of no benefit to either OS (HR =0.72, 95% CI: 0.49–1.06, P=0.094) or DFS (HR =1.45, 95% CI: 1.00–2.09, P=0.047). In summary, compared with postoperative chemotherapy, POCRT was beneficial to OS but not DFS in patients with stage IIIA N2 non-small-cell lung cancer.

Keywords:
NSCLC, N2-stage, therapy, surgery

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