Originally published as JCO Early Release 10.1200/JCO.2005.04.6110 on June 12 2006

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lally, B. E. Articles by Wilson, L. D. Search for Related Content PubMed PubMed Citation Articles by Lally, B. E. Articles by Wilson, L. D. Related Articles Related Editorial Related Correspondence Social Bookmarking                            What's this?

Postoperative Radiotherapy for Stage II or III Non–Small-Cell Lung Cancer Using the Surveillance, Epidemiology, and End Results Database

Brian E. Lally, Daniel Zelterman, Joseph M. Colasanto, Bruce G. Haffty, Frank C. Detterbeck, Lynn D. Wilson

From the Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC; Division of Biostatistics, Yale University School of Public Health; Departments of Therapeutic Radiology and Surgery, Yale University School of Medicine, New Haven, CT; and the Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, Piscataway, NJ

Address reprint requests to Brian E. Lally, MD, Wake Forest University School of Medicine, Department of Radiation Oncology, Medical Center Blvd, Winston-Salem, NC 27157-1030; e-mail: blally{at}wfubmc.edu

PURPOSE: To investigate the association between survival and postoperative radiotherapy (PORT) in patients with resected non–small-cell lung cancer (NSCLC).

PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results database, we selected patients with stage II or III NSCLC who underwent a lobectomy or pneumonectomy. Only those patients coded as receiving PORT or observation were included. To account for perioperative mortality, we excluded patients who survived less than 4 months. As a result of our inclusion criteria, we selected a total of 7,465 patients, with a median follow-up time of 3.5 years for patients still alive.

RESULTS: Predictors for the use of PORT included age less than 50 years, higher American Joint Committee on Cancer stage, T3-4 tumor stage, larger tumor size, advanced node stage, greater number of lymph nodes involved, and a ratio of lymph nodes involved to lymph nodes sampled approaching 1.00. On multivariate analysis, older age, T3-4 tumor stage, N2 node stage, male sex, fewer sampled lymph nodes, and greater number of involved lymph nodes had a negative impact on survival. The use of PORT did not have a significant impact on survival. However, in subset analysis for patients with N2 nodal disease (hazard ratio [HR] = 0.855; 95% CI, 0.762 to 0.959; P = .0077), PORT was associated with a significant increase in survival. For patients with N0 (HR = 1.176; 95% CI, 1.005 to 1.376; P = .0435) and N1 (HR = 1.097; 95% CI, 1.015 to 1.186; P = .0196) nodal disease, PORT was associated with a significant decrease in survival.

CONCLUSION: In a population-based cohort, PORT use is associated with an increase in survival in patients with N2 nodal disease but not in patients with N1 and N0 nodal disease.

Supported by National Institutes of Health Grant No. 1T32CA113267-01, TRADONC Fellowship (B.E.L.).

Presented at the 47th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Denver, CO, October 16-20, 2005.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Editorial

• Postoperative Radiotherapy in Non—Small-Cell Lung Cancer Warrants Further Exploration in the Era of Adjuvant Chemotherapy and Conformal Radiotherapy
  James A. Bonner and Sharon A. Spencer
  JCO 2006 24: 2978-2980 [Full Text]

Related Correspondence

• Since Chemotherapy Is Now the Standard in Node-Positive Lung Cancer, What Is the Role of Postoperative Radiotherapy?
  Andrew Turrisi and Steven Keller
  JCO 2007 25: 459-460 [Full Text]
• Need for a New Trial to Evaluate Adjuvant Postoperative Radiotherapy in Non–Small-Cell Lung Cancer Patients With N2 Mediastinal Involvement
  Cecile Le Péchoux, Ariane Dunant, Jean-Pierre Pignon, Dirk De Ruysscher, Françoise Mornex, Suresh Senan, Francesc Casas, Allan Price, and Bernard Milleron
  JCO 2007 25: 10-11 [Full Text]

This article has been cited by other articles:

				L. Chhatwani, E. Cabebe, and H. A. Wakelee Adjuvant Treatment of Resected Lung Cancer Proceedings of the ATS, April 15, 2009; 6(2): 194 - 200. [Abstract] [Full Text] [PDF]

				R. Bordoni Consensus Conference: Multimodality Management of Early- and Intermediate-Stage Non-Small Cell Lung Cancer Oncologist, September 1, 2008; 13(9): 945 - 953. [Abstract] [Full Text] [PDF]

				H. Matsuguma, R. Nakahara, Y. Ishikawa, H. Suzuki, K. Inoue, S. Katano, and K. Yokoi Postoperative radiotherapy for patients with completely resected pathological stage IIIA-N2 non-small cell lung cancer: focusing on an effect of the number of mediastinal lymph node stations involved Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 573 - 577. [Abstract] [Full Text] [PDF]

				J.-P. Pignon, H. Tribodet, G. V. Scagliotti, J.-Y. Douillard, F. A. Shepherd, R. J. Stephens, A. Dunant, V. Torri, R. Rosell, L. Seymour, et al. Lung Adjuvant Cisplatin Evaluation: A Pooled Analysis by the LACE Collaborative Group J. Clin. Oncol., July 20, 2008; 26(21): 3552 - 3559. [Abstract] [Full Text] [PDF]

				G A Silvestri and S G Spiro Carcinoma of the bronchus 60 years later Postgrad. Med. J., April 1, 2008; 84(990): 182 - 187. [Full Text] [PDF]

				K. M.W. Pisters, W. K. Evans, C. G. Azzoli, M. G. Kris, C. A. Smith, C. E. Desch, M. R. Somerfield, M. C. Brouwers, G. Darling, P. M. Ellis, et al. Cancer Care Ontario and American Society of Clinical Oncology Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non Small-Cell Lung Cancer Guideline J. Clin. Oncol., December 1, 2007; 25(34): 5506 - 5518. [Abstract] [Full Text] [PDF]

				S. Dubey and C. A. Powell Update in Lung Cancer 2006 Am. J. Respir. Crit. Care Med., May 1, 2007; 175(9): 868 - 874. [Full Text] [PDF]

				R. P. Petersen, D. Pham, W. R. Burfeind, S. I. Hanish, E. M. Toloza, D. H. Harpole Jr, and T. A. D'Amico Thoracoscopic Lobectomy Facilitates the Delivery of Chemotherapy after Resection for Lung Cancer Ann. Thorac. Surg., April 1, 2007; 83(4): 1245 - 1250. [Abstract] [Full Text] [PDF]

				C. Le Pechoux, A. Dunant, J.-P. Pignon, D. De Ruysscher, F. Mornex, S. Senan, F. Casas, A. Price, and B. Milleron Need for a New Trial to Evaluate Adjuvant Postoperative Radiotherapy in Non-Small-Cell Lung Cancer Patients With N2 Mediastinal Involvement J. Clin. Oncol., March 1, 2007; 25(7): e10 - e11. [Full Text] [PDF]

				A. Turrisi and S. Keller Since Chemotherapy Is Now the Standard in Node-Positive Lung Cancer, What Is the Role of Postoperative Radiotherapy? J. Clin. Oncol., February 1, 2007; 25(4): 459 - 460. [Full Text] [PDF]

				B. E. Lally, D. Zelterman, J. M. Colasanto, B. G. Haffty, F. C. Detterbeck, and L. D. Wilson In Reply J. Clin. Oncol., February 1, 2007; 25(4): 460 - 461. [Full Text] [PDF]

				B. E. Lally, D. Zelterman, J. Colasanto, B. G. Haffty, F. C. Detterbeck, and L. D. Wilson In Reply J. Clin. Oncol., December 10, 2006; 24(35): 5612 - 5613. [Full Text] [PDF]

				N. H. Hanna and L. H. Einhorn Postoperative Chemotherapy for N2 Non Small-Cell Lung Cancer: Conclusions Are Not Black and White, but Gray J. Clin. Oncol., December 10, 2006; 24(35): 5611 - 5612. [Full Text] [PDF]

				G A Silvestri and S G Spiro Carcinoma of the bronchus 60 years later. Thorax, December 1, 2006; 61(12): 1023 - 1028. [Full Text] [PDF]

				J. A. Bonner and S. A. Spencer Postoperative Radiotherapy in Non--Small-Cell Lung Cancer Warrants Further Exploration in the Era of Adjuvant Chemotherapy and Conformal Radiotherapy J. Clin. Oncol., July 1, 2006; 24(19): 2978 - 2980. [Full Text] [PDF]