Postoperative Radiotherapy Associated Clinical Investigation In Non-small Cell Lung Cancer Treatment Outcomes And Prognosis For Masaoka Stage Ⅲ Thymoma

Purpose:To evaluate the incidence and risk factors for symptomatic radiation-induced lung toxicity (SRILT) in non-small cell lung cancer (NSCLC) patients treated with modern radiotherapy after surgery.Methods and Materials:Consecutive NSCLC patients treated with postoperative radiotherapy (PORT) after surgery in our institution between November2002and December2011were retrospectively reviewed. SRILT was defined as≥grade2radiation-induced lung toxicity using the Common Terminology Criteria for Adverse Events (CTCAE, version3.0). Potential clinical risk factors and dosimetric parameters for SRILT were evaluated using logistic regression modeling. Receiver operating characteristic (ROC) curves were constructed to determine the optimal cut-off points for dosimetric parameters.Results:The median follow-up time was48months (7-112months). A total of221patients were included for analysis with37patients receiving pneumonectomy and190receiving lobectomy followed by PORT. Twenty-three patients (10.1%) developed SRILT among patients with lobectomy including17patients with grade2,5patients with grade3and1patients with grade4, while no SRILT occurred in patients with pneumonectomy. In the lobectomy group, univariate analysis showed that postoperative concurrent chemoradiotherapy (P=0.05) had a significantly higher incidence of SRILI among clinical factors, and the volume of PTV (P=0.015), mean lung dose (P=0.048) and V20through V40were associated with SRILT among dosimetric parameters. On multivariate analysis, postoperative concurrent chemoradiotherapy (compared with radiotherapy alone, Odds Ratio [OR]:7.796,95%Confidence Interval [CI]:1.443-42.106; P=0.017) and V20(OR:0.206,95%CI:0.063-0.672; P=0.009) were associated with SRILT significantly.Conclusion:The incidence of SRILT for PORT with modern technique was acceptable and relatively low. Postoperative chemoradiotherapy and V20were risk factors associated with SRILT in NSCLC patients who received PORT. Purpuse:To evaluate the pattern of failure, actuarial risk and risk factors for locoregional recurrence (LR) in order to identify the subset of N1non-small cell lung cancer (NSCLC) patients who were associated with the highest risk of LR.Methods and Materials:We conducted a retrospective study on199patients with pathologically confirmed T1-3N1M0NSCLC who underwent surgery. None of the patients had positive surgical margins or received preoperative therapy or PORT. The median follow-up was53.8months. Complete mediastinal lymph node (MLN) dissection and examination was defined as≥3dissected and examined MLN stations; incomplete MLN dissection or examination (IMD) was defined as<3dissected or examined MLN stations. The primary end point of this study was freedom from LR (FFLR). Differences between patient groups were compared and risk factors for LR were identified by univariate and multivariate analyses.Results:LR was identified in41(20.6%) patients, distant metastasis (DM) was identified in79(39.7%) patients and concurrent LR and DM was identified in25(12.6%) patients. The3-and5-year OS rates in patients with resected N1NSCLC were78.4%and65.6%, respectively. The corresponding FFLR rates were80.8%and77.3%, respectively. Univariate analyses identified that nonsmokers,≤23dissected lymph nodes, visceral pleural invasion and lymph node ratio>10%were significantly associated with lower FFLR rates (P<0.05). Multivariate analyses further confirmed positive lymph nodes at station10and IMD as risk factors for LR (P<0.05). The5-year LR rate was highest in patients with both these risk factors (48%).Conclusions:The incidence of LR in patients with surgically resected T1-3N1M0NSCLC is high. Patients with IMD and positive lymph nodes at station10have the highest risk of LR, and may therefore benefit from adjuvant PORT. Further investigations of PORT in this subset of patients are warranted. Purpose:To analyze the treatment outcomes and the prognostic factors for patients with Masaoka stage Ⅲ thymoma.Methods and Meterials:Between September1965and December2010, a total of111patients with stage Ⅲ thymoma treated in our hospital were retrospectively analyzed. Sixty-eight patients (61.3%) had complete resection, while23patients (20.7%) had incomplete resection and20patients (18%) had pure biopsy (18patients with thoracic exploration surgery and2patients with CT-guidied fine needle puncture biopsy). Eighty-seven patients received surgery plus postoperative radiotherapy (PORT) while24patients received suergery alone. Forteen patients received preoperative radiotherapy including8patients consecutively underwent PORT after surgery.Results:The median follow-up time was66months (5-540). PORT did not improve overall survival (OS), disease free survival (DFS) or disease specific survival (DSS),(P=0.316, P=0.729and P=0.601, respectively). Patients with complete resection had improved OS (P=0.002), DFS (P=0.003) and DSS (P=0.004) compared with patients with incomplete resection and pure biopsy. Though PORT reduced the local recurrence rate, the difference was not statistically significant (P=0.173). On multivariate analysis, resection completeness was an independent prognostic factor for OS, DFS and DSS. Age was an independent prognostic factor for OS.Conclusions:Patients with complete tumor resection had improved survival and lower recurrence rates compared with patients with incomplete tumor resection or tumor biopsy only. The role of PORT is still controversial for stage Ⅲ thymoma, which needs randomized clinical trial to identify. Purpose:To evaluate the effect of postoperative radiotherapy (PORT) on survival as well as tumor control in patients with completely resected Masaoka stage III thymoma.Methods and Meterials:Between June1982and December2010,65patients who underwent complete resection of stage III thymoma entered the study. Fifty-three patients had adjuvant RT after surgery (S+R) and12had surgery only (S alone). Of patients who had adjuvant RT,28had three-dimensional conformal RT (3D-CRT)/intensity modulated RT (IMRT) and25had conventional RT. A median prescribed dose of56Gy (range,28-60Gy) was given.Results:The median follow-up time was50months (range,5-360months). Five-and10-year overall survival (OS) rates were91.7%and71.6%, respectively, for S+R and81.5%and65.2%for S alone (P=0.5). In the subgroup analysis, patients with3D-CRT/IMRT showed a trend of improved5-year OS rate compared with conventional RT (100%vs.86.9%, P=0.12). Compared with S alone, the5-year OS rate was significantly improved (100%vs.81.5%, P=0.049). Relapses occurred in15patients (23.1%). There was a trend of lower crude local recurrence rates for S+R (3.8%) compared with S alone (16.7%)(P=0.09), whereas the crude regional recurrence were similar (P=0.9). No clear dose-response relationship was found according to prescribed doses. Conclusion:Adjuvant3D-CRT/IMRT showed potential advantages in improving survival and reducing relapse in patients with stage Ⅲ thymoma after complete resection, whereas PORT did not significantly improve survival or reduce recurrence for the cohort as a whole. Doses of≤50Gy may be effective and could be prescribed for adjuvant RT. To confirm the role of adjuvant3D-CRT/IMRT in patients who undergo a complete resection of thymoma, a multicenter randomized study should be performed.