| Purpose:This study aimed to analyze the local-regional failure(LRF)patterns in completely resected p?A-N2 non-small cell lung cancer(NSCLC)and guide the design of target volumes for postoperative radiotherapy(PORT).Methods and materials:From Jan.2003 to Dec.2015,consecutive patients with pathologic ?A-N2 NSCLC who had undergone complete resection with or without adjuvant chemotherapy in our hospital were retrospectively reviewed.Those who had not received PORT and neoadjuvant therapy were included in this study.Disease recurrences occurring at the bronchial stump(BS),ipsilateral or contralateral hilum,mediastinum and supraclavicular fossa during follow-up period were defined as LRF.LRF patterns were constructed to illustrate sites of first failure on the basis of the primary tumor location.The clinicopathological factors related to LRF were assessed by Cox's proportional hazards model.Results:With a median follow-up of 27 months,537 of 1024 patients(52.4%)experienced treatment failure.LRF as the first event was observed in 233 patients.The most frequent sites of relapse were lymph node station(LNS)4R(11.2%),followed by LNS 2R(9.4%),LNS 7(6.7%),LNS 1R(6.0%)and bronchial stump(BS)(5.0%)for right-sided tumors;and LNS 4L(7.4%),followed by LNS 4R(6.7%),BS(6.3%),LNS 7(5.9%)and LNS 6(5.2%)were the most frequent sites of relapse for left-sided tumors.On multivariate analysis,patients with cN2(hazard ratio[HR]=1.32,95%confidence interval[CI]:1.02-1.71,p=0.04),squamous cell carcinoma(HR=1.42,95%CI:1.08-1.87,p=0.01),pT3(HR=1.79,95%CI:1.06-3.03,p=0.03)and adjuvant chemotherapy(HR=1.49,95%CI:1.14-1.94,p<0.001)were more likely to experience first site LRF.Conclusions:For patients with completely resected p?A-N2 NSCLC,PORT results in extra benefit of local-regional control.The PORT CTV contouring protocol is presumed to be tumor location dependent.And the clinicopathological factors should also be taken into consideration.Purpose:Postoperative radiotherapy(PORT)decreased local-regional failure(LRF)in patients with resected stage p?A-N2 non-small cell lung cancer(NSCLC)in our prospective randomized phase ? studies(PORT-C).However,LRF patterns after PORT are less well characterized.To investigate the timing and patterns of LRF in stage ?A-N2 NSCLC patients with complete resection and adjuvant chemotherapy.Methods and materials:The study cohort included pathology confirmed stage ?A-N2 NSCLC patients treated with complete resection and adjuvant chemotherapy from 2003 to 2015.LRF was defined as bronchial stump,ipsilateral hilum,mediastinum,and/or supraclavicular region.And the proposed PORT clinical target volume(CTV)included the bronchial stump,ipsilateral hilum,subcarinal region,and ipsilateral mediastinum.The planned target volume(PTV)was determined as the CTV plus a 0.5-cm margin.The hazard rate function was used to evaluate the recurrence dynamics.Results:With a median follow-up of 37.4 months,507 of 854 patients experienced the pattern of first LRF.Non-postoperative radiotherapy(Non-PORT)and PORT were delivered to 573 and 281 patients,respectively.LRF was seen in 149 patients in the Non-PORT group(26.0%)and 51 in the PORT group(18.1%).Spatial distribution analysis showed that the most frequent sites of LRF were the ipsilateral lymph node station(LNS)4(9.6%),ipsilateral LNS 2(7.5%),and LNS 7(7.5%)in the Non-PORT group and contralateral LNS 1(5.7%),and ipsilateral LNS 1(4.6%)in the PORT group.The recurrence rates of ipsilateral LNS 2,ipsilateral LNS 4,and LNS 7 in the PORT group were significantly lower than those in the Non-PORT group.The dominant pattern of LRF was inside(inside or both inside and outside)the PTV.Regarding the inside-of-PTV recurrences,47.7%and 21.6%of LRF occurred in the PTV for the Non-PORT and PORT groups,respectively(p<0.001).Temporal distribution analysis showed a lower tumor recurrence hazard rate with PORT than with Non-PORT.What's more,PORT postponed 6 months of the first LRF during the follow-up period.Conclusions:Despite the limitations of this retrospective study,our data support the role of PORT in decreasing LRF.PORT showed advantages over Non-PORT in spatial-temporal LRF patterns,especially in mediastinum metastasis.Purpose:To investigate the timing and pattern of recurrence of patients with pIIIA-N2 non-small cell lung cancer(NSCLC)after complete resection followed by adjuvant chemotherapy.Methods and materials:Between 2003 and 2015,patients with p?A-N2 NSCLC treated with complete resection followed by adjuvant chemotherapy in our single institution were included in the study.Recurrence was categorized as local-regional recurrence(LRR),distant metastasis(DM),and both LRR and DM.The risk distribution was assessed by using clinical and pathological factors.The hazard rate function and competing risk analysis were used to evaluate the recurrence dynamics.The Gray's test was employed to estimate the cumulative recurrence rates and compare the differences between groups.Results:Among 854 patients,61.9%had multiple N2 station involvement.The 1,3,and 5-year cumulative incidence rates of recurrence were 16.9%,50.7%,and 67.4%,respectively.Of the 510 patients who experienced recurrence,95(18.6%)experienced LRR,285(55.9%)experienced DM,whereas 130(25.5%)had both LRR and DM.The hazard rate function for overall recurrence revealed a continuous increase between 0-18 months after surgery,a consistent high level during 18-48 months,and marked decline thereafter.And the DM displayed a hazard rate curve similar to that of overall recurrence.However,a double-peaked pattern of hazard rate was present in LRR and both LRR and DM.What's more,the peak recurrence frequency of DM differed by organs.A comparison of clinical and pathological factors revealed that patients with higher pT stage,mutliple pN2 station,and postoperative radiotherapy had a higher recurrence risk but a similar pattern of recurrence.Conclusions:The recurrence of ?A-N2 NSCLC after complete resection and adjuvant chemotherapy increased to a high level in 18 months and maintained till 48 months after surgery,which hinted necessity of intensive follow-up during this period.This follow-up strategy implied individualized surveillance for N2 disease which was different from clinical routine and should be verified in further studies.Purpose:We aimed to investigate the association between postoperative radiotherapy(PORT)and cardiac-related mortality for patients with IIIA-N2 non-small cell lung cancer(NSCLC)by the Surveillance,Epidemiology,and End Results(SEER)database.Methods and materials:The United States(US)population based SEER database were queried for cardiac-related mortality among patients with ?A-N2 NSCLC.Cardiac-related mortality was compared between PORT and non-postoperative radiotherapy(Non-PORT)group.Accounting for mortality from other causes,Gray's test compared cumulative incidences of cardiac-related mortality between both groups.Univariate and multivariate analysis were performed using the competing risk model.Results:From 1988 to 2016,7290 patients met the inclusion criteria:3386 patients treated with PORT and 3904 patients treated with Non-PORT.The 5-year overall incidence of cardiac-related mortality was 3.01%in PORT group and 3.26%in Non-PORT group.Older age,male sex,squamous cell lung cancer,earlier year of diagnosis and earlier T stage were independent adverse factors for cardiac-related mortality.However,PORT use wasn't associated with an increase in the hazard for cardiac-related mortality(subdistribution hazard ratio[SHR]=0.99,95%confidence interval[95%CI],0.78-1.24,p=0.91).When evaluating cardiac-related mortality in each time period,the overall incidence of cardiac-related mortality was decreased over time.There were no statistically significant differences based on PORT use in all time periods.Conclusions:With a median follow-up of 25 months,no significant differences were found in cardiac-related mortality between PORT and Non-PORT for ?A-N2 NSCLC patients. |
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