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

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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.

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]

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