Division of the N2 Stage According to the Multiplicity of the Involved Nodal Stations May be Necessary in the N2-NSCLC Patients Who are Treated with Postoperative Radiotherapy.
10.3857/jkstro.2009.27.3.126
- Author:
Hong In YOON
1
;
Yong Bae KIM
;
Chang Geol LEE
;
Ik Jae LEE
;
Songyih KIM
;
Jun Won KIM
;
Joo Hang KIM
;
Byung Chul CHO
;
Jin Gu LEE
;
Kyung Young CHUNG
Author Information
1. Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. ikjae412@yuhs.ac
- Publication Type:Original Article
- Keywords:
Non-small cell lung cancer;
Mediastinal nodal metastasis;
Postoperative radiotherapy;
Multiple station involvement
- MeSH:
Carcinoma, Non-Small-Cell Lung;
Disease-Free Survival;
Humans;
Mastectomy, Segmental;
Multivariate Analysis;
Pneumonectomy;
Recurrence;
Retrospective Studies
- From:The Journal of the Korean Society for Therapeutic Radiology and Oncology
2009;27(3):126-132
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: We wanted to evaluate the prognostic factors for the pathologic N2 non-small cell lung cancer (NSCLC) patients who were treated by postoperative radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed 112 pN2 NSCLC patients who underwent surgery and postoperative radiotherapy (PORT) From January 1999 to February 2008. Seventy-five (67%) patients received segmentectomy or lobectomy and 37 (33%) patients received pneumonectomy. The resection margin was negative in 94 patients, and it was positive or close in 18 patients. Chemotherapy was administered to 103 (92%) patients. Nine (8%) patients received PORT alone. The median radiation dose was 54 Gy (range, 45 to 66), and the fraction size was 1.8~2 Gy. RESULTS: The 2-year overall survival (OS) rate was 60.2% and the disease free survival (DFS) rate was 44.7% for all the patients. Univariate analysis showed that the patients with multiple-station N2 disease had significantly reduced OS and DFS (p=0.047, p=0.007) and the patients with an advanced T stage (> or =T3) had significantly reduced OS and DFS (p<0.001, p=0.025). A large tumor size (> or =5 cm) and positive lymphovascular invasion reduced the OS (p=0.035, 0.034). Using multivariate analysis, we found that multiple-station N2 disease and an advanced T stage (> or =T3) significantly reduced the OS and DFS. Seventy one patients (63.4%) had recurrence of disease. The patterns of failure were loco-regional in 23 (20.5%) patients, distant failure in 62 (55.4%) and combined loco-regional and distant failure in 14 (12.5%) patients. CONCLUSION: Multiple involvement of mediastinal nodal stations for the pN2 NSCLC patients with PORT was a poor prognostic factor in this study. A prospective study is necessary to evaluate the N2 subclassification and to optimize the adjuvant treatment.
