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. 2021 May 20;13(10):2494.
doi: 10.3390/cancers13102494.

Long-Term Survival Effect of the Interval between Postoperative Chemotherapy and Radiotherapy in Patients with Completely Resected Pathological N2 Non-Small-Cell Lung Cancer

Shih-Min Lin  1 , Hsiu-Ying Ku  2   3 , Che-Yu Hsu  4   5   6 , Chih-Liang Wang  7   8 , Gee-Chen Chang  9   10 , Cheng-Shyong Chang  11 , Tsang-Wu Liu  2
Affiliations

Long-Term Survival Effect of the Interval between Postoperative Chemotherapy and Radiotherapy in Patients with Completely Resected Pathological N2 Non-Small-Cell Lung Cancer

Shih-Min Lin et al. Cancers (Basel). .

Abstract

(1) Purpose: To investigate the effects of the time interval between initiation of adjuvant chemotherapy and radiotherapy on survival outcomes in patients with completely resected stage IIIA pN2 non-small-cell lung cancer (NSCLC); (2) Methods: Data on 2515 patients with completely resected stage IIIA pN2 NSCLC in 2007-2017 were extracted from the Taiwan Cancer Registry Database. The survival outcomes in patients who underwent concurrent chemoradiotherapy (CCRT) and sequential chemotherapy and radiotherapy (SCRT) with either a short (SCRT1) or long (SCRT2) interval between treatments were estimated using Kaplan-Meier, Cox regression, and propensity score matching (PSM); (3) Results: Multivariate analyses of OS showed that SCRT2 (hazard ratio [HR] 0.64, p = 0.017) was associated with improved overall survival (OS). After PSM, the median OS periods were 64 and 75 months in the SCRT1 and SCRT2 groups, respectively, which differed significantly from that of 58 months in the CCRT group (p = 0.003). In elderly patients, SCRT2 significantly improved survival relative to CCRT before PSM (p = 0.024) and after PSM (p = 0.002); (4) Conclusions: A longer interval between initiation of adjuvant chemotherapy and postoperative radiotherapy (PORT; SCRT2) improved OS relative to CCRT; the benefits were greater in elderly patients (age >60 years).

Keywords: IMRT; NSCLC; pN2; postoperative chemotherapy; postoperative radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart representing the selection of completely resected pN2 NSCLC patients over the course of the study. Abbreviations: CCRT: concurrent chemoradiation; CT: chemotherapy; NSCLC: non-small-cell lung cancer; RT: radiotherapy; SCRT1: sequential chemoradiation group 1; SCRT2: sequential chemoradiation group 2; TCRD: Taiwan Cancer Registry Database.
Figure 2
Figure 2
Kaplan–Meier survival curves of OS in patients treated according to three PORT schedules (CCRT, SCRT1 [15–103 days], SCRT2 [104–180 days]). (A) Before PSM, log-rank test, p = 0.095; CCRT vs. SCRT1, p = 0.94; CCRT vs. SCRT2, p = 0.037; and (B) After PSM, log-rank test, p = 0.003; CCRT vs. SCRT1, p = 0.188; CCRT vs. SCRT2, p < 0.01). Abbreviations: CCRT: concurrent chemoradiation; OS: overall survival; PORT: postoperative radiotherapy; PSM: propensity score matching; SCRT1: sequential chemoradiation group 1; SCRT2: sequential chemoradiation group 2.
Figure 3
Figure 3
Forest plots of aHRs showing the effect of PORT timing on OS. The 95% CIs are also shown. Abbreviations: aHR: adjusted hazard ratio; CCRT: concurrent chemoradiation; OS: overall survival; PORT: postoperative radiotherapy; SCRT1: sequential chemoradiation group 1; SCRT2: sequential chemoradiation group 2; CIs: confidence intervals.
Figure 4
Figure 4
Kaplan–Meier OS curves in patients treated according to the three PORT schedules (CCRT, SCRT1 [15–103 days], SCRT2 [104–180 days]) in subgroups stratified by age. (A) Age >60 years, before PSM, log-rank test, p = 0.024; (B) Age >60 years, after PSM, log-rank test, p = 0.002; (C) Age ≤60 years, before PSM, log-rank test, p = 0.856; (D) Age ≤60 years, after PSM, log-rank test, p = 0.871. Abbreviations: CCRT: concurrent chemoradiation; OS: overall survival; PORT: postoperative radiotherapy; PSM: propensity score matching; SCRT1: sequential chemoradiation group 1; SCRT2: sequential chemoradiation group 2.
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