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  • [Int J Radiat Oncol Biol Phys] Radiation Therapy-First Strategy After Surgery With or Without Adjuvant Chemotherapy in Stage IIIA-N2 Non-Small Cell Lung Cancer.

    [Int J Radiat Oncol Biol Phys] Radiation Therapy-First Strategy After Surgery With or Without Adjuvant Chemotherapy in Stage IIIA-N2 Non-Small Cell Lung Cancer.

    아주의대 / 노오규*

  • 출처
    Int J Radiat Oncol Biol Phys
  • 등재일
    2016 Mar 1
  • 저널이슈번호
    94(3):621-7. doi: 10.1016/j.ijrobp.2015.11.020. Epub 2015 Nov 18.
  • 내용

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    Abstract
     

    PURPOSE:

     

    Postoperative radiation therapy (PORT) and postoperative chemotherapy (POCT) can be administered as adjuvant therapies in patients with non-small cell lung cancer (NSCLC). The aim of this study was to present the clinical outcomes in patients treated with PORT-first with or without subsequent POCT in stage IIIA-N2 NSCLC.

     

    METHODS AND MATERIALS:

    From January 2002 to November 2014, the conditions of 105 patients with stage IIIA-N2 NSCLC who received PORT-first with or without subsequent POCT were analyzed. PORT was initiated within 4 to 6 weeks after surgical resection. Platinum-based POCT was administered 3 to 4 weeks after the completion of PORT. We analyzed the outcomes and the clinical factors affecting survival.

     

    RESULTS:

    Of 105 patients, 43 (41.0%) received POCT with a median of 4 cycles (range, 2-6 cycles). The follow-up times ranged from 3 to 123 months (median, 30 months), and the 5-year overall survival (OS) was 40.2%. The 5-year OS of patients treated with PORT and POCT was significantly higher than that of patients with PORT (61.3% vs 29.2%, P<.001). The significant prognostic factors affecting OS were the use of POCT (hazard ratio [HR] = 0.453, P=.036) and type of surgery (pneumonectomy/lobectomy; HR = 2.845, P<.001).

     

    CONCLUSIONS:

    PORT-first strategy after surgery appeared not to compromise the clinical outcomes in the treatment of stage IIIA-N2 NSCLC. The benefit of POCT on OS was preserved even in the PORT-first setting. Further studies are warranted to compare the sequencing of PORT and POCT, guaranteeing the proper use of POCT. 

    Author information

    Lee HW1, Noh OK2, Oh YT3, Choi JH1, Chun M3, Kim HI3, Heo J3, Ahn MS1, Park SY4, Park RW5, Yoon D5.

    1Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.

    2Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea. Electronic address: okyu.noh@gmail.com.

    3Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.

    4Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.

    5Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.

  • 연구소개
    비소세포성 폐암의 수술후 IIIA-N2 병기에서 재발 확률을 감소시키기 위한 보조적치료로 항암화학치료와 방사선치료가 시행될 수 있다. 대부분의 경우 단지 항암화학치료의 유익에 대한 증거 수준이 방사선치료에 비해 높다는 이유로, 방사선치료의 투여 시기가 지연된다. 그러나 아주대학교병원에서는 보조적치료의 효율을 극대화한다는 측면에서, 잔존암의 확률이 높은 국소부위에 방사선치료를 먼저 시행하는 전략으로 치료를 시행하였고, 그 결과 기존의 치료성적보다 좋은 치료 결과를 보였다. 비록 후향적연구이며 치료 순서를 간접비교한 연구이지만, 방사선치료를 먼저 시행하는 전략이 유효할 수 있음을 보여주는 논문이다.
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