Effect Of PORT For Completely Resected Stage ⅢA-N2 Non-small Cell Lung Cancer

PartⅠ:Effect of PORT for completely resceted stageⅢA-N2 non-small cell lung cancerObjective To retrospectively analyze the role of postoperative radiotherapy(PORT) in patients with completely resected stageⅢA-N2 non-small cell lung cancer(NSCLC)and identify the potential prognostic factors.Methods From Jan 2003 to Dec 2005 221 patients with completely resected pathological stageⅢA-N2 NSCLC cancer was analyzed,96 cases received PORT.161 patients(72.9%) were treated with median 4 cycles of adjuvant chemotherapy.Results The median survival time(MST),1-,3- and 5-years overall survival rates(OS) was 43.9 months,94.8%,59.1%,34.3%for PORT group vesus 31.8 months,77.6%,45.4%,30.6%for group without PORT(P=0.046).The difference in the rates of loco-regional relapse-free survival(LRRFS),distant metastasis-free survival(DMFS) and disease-free survival(DFS) between the two groups both reached a statistically significance.Stratified analysis showed survival was improved in patients received PORT,both in the patients with chemotherapy(MST48.3 vs.33.1 months) and without(MST 38.3 vs.21.6 months). Patients received chemoradiotherapy got better survival outcome than patients received either chemotherapy or PORT,those patients without any adjuvant therapy had the worst survival outcome.Subgroups with clinical N2 stage,squamous cell carcinoma types, stage T3,no less than 4 lymph node involved could gain definite survival benefit from PORT.Intercurrent death rate was 5.3%in PORT group and 6.4%in group without PORT(P=0.493).In multivariable Cox proportional hazards models,percentage of involved lymph nodes,clinical N stage,PORT and adjuvant chemotherapy were independent prognostic factors.Conclusions PORT can improve survival in patients with completely resceted stageⅢA-N2 NSCLC.Subgroups with clinical N2 stage, squamous cell carcinoma type,stage T3,no less than 4 lymph node involved can gain definite survival benefit from PORT.clinical N stage,percentage of involved lymph nodes,postoperative radiotherapy and adjuvant chemotherapy were independent prognostic factors. PartⅡ:Postoperative Radiotherapy for Non-Small Cell Lung Cancer: A Comparison of Three-Dimensional Conformal Radiotherapy with Conventional RadiotherapyObjective To evaluate the survival outcome,pattern of failure and therapy-related side effect of postoperative Three-Dimensional Conformal Radiotherapy(3DCRT) and Conventional Radiotherapy in patients with resected non-small-cell lung cancer(NSCLC).Methods 162 patients with stageⅠB-ⅢB NSCLC received postoperative radiotherapy from Nov.2002 to Mar 2006 was restrospetcively analyzed.86 patients received 3DCRT,76 patients receieved conventional radiotherapy among the whole group.The median follow-up was 29.4 months in the 3DCRT group and 24 months in the conventional radiation group.Resulets There was statistically significant difference between 3DCRT group and conventional radiation group in terms of local-regional free survival(χ~2 =5.458 P= 0.019).No statistically significant difference was found in overall survival,disease-flee survival and distant metastasis-free survival between the two group.Statistically significant difference was found in local-regional failure rate between the 3DCRT group and conventional radiation group (14.5%vs 33.3%χ~2 =7.704 P=0.006),No statistically significant difference was found about the incidence of distant metastasis between the two group(χ~2 =0.015 P= 0.904). Pneumonitis for NCI CTC grade 2-3 occured in 10 patients(11.6%) in 3DCRT gourp and 18 patients(23.7%) in conventional radiation group.Incidence of radiation pneumonitis grade 2-3 was Statistically different:among the two group(χ~2= 4.102 P=0.043). Conclusions Postoperative 3DCRT for NSCLC provide a better local-regional control and lower incidence of radiation pneumonitis compared with conventional therapy.