1
|
Ma Z, Men Y, Liu Y, Bao Y, Liu Q, Yang X, Wang J, Deng L, Zhai Y, Bi N, Wang L, Hui Z. Preoperative CT-based radiomic prognostic index to predict the benefit of postoperative radiotherapy in patients with non-small cell lung cancer: a multicenter study. Cancer Imaging 2024; 24:61. [PMID: 38741207 DOI: 10.1186/s40644-024-00707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The value of postoperative radiotherapy (PORT) for patients with non-small cell lung cancer (NSCLC) remains controversial. A subset of patients may benefit from PORT. We aimed to identify patients with NSCLC who could benefit from PORT. METHODS Patients from cohorts 1 and 2 with pathological Tany N2 M0 NSCLC were included, as well as patients with non-metastatic NSCLC from cohorts 3 to 6. The radiomic prognostic index (RPI) was developed using radiomic texture features extracted from the primary lung nodule in preoperative chest CT scans in cohort 1 and validated in other cohorts. We employed a least absolute shrinkage and selection operator-Cox regularisation model for data dimension reduction, feature selection, and the construction of the RPI. We created a lymph-radiomic prognostic index (LRPI) by combining RPI and positive lymph node number (PLN). We compared the outcomes of patients who received PORT against those who did not in the subgroups determined by the LRPI. RESULTS In total, 228, 1003, 144, 422, 19, and 21 patients were eligible in cohorts 1-6. RPI predicted overall survival (OS) in all six cohorts: cohort 1 (HR = 2.31, 95% CI: 1.18-4.52), cohort 2 (HR = 1.64, 95% CI: 1.26-2.14), cohort 3 (HR = 2.53, 95% CI: 1.45-4.3), cohort 4 (HR = 1.24, 95% CI: 1.01-1.52), cohort 5 (HR = 2.56, 95% CI: 0.73-9.02), cohort 6 (HR = 2.30, 95% CI: 0.53-10.03). LRPI predicted OS (C-index: 0.68, 95% CI: 0.60-0.75) better than the pT stage (C-index: 0.57, 95% CI: 0.50-0.63), pT + PLN (C-index: 0.58, 95% CI: 0.46-0.70), and RPI (C-index: 0.65, 95% CI: 0.54-0.75). The LRPI was used to categorize individuals into three risk groups; patients in the moderate-risk group benefited from PORT (HR = 0.60, 95% CI: 0.40-0.91; p = 0.02), while patients in the low-risk and high-risk groups did not. CONCLUSIONS We developed preoperative CT-based radiomic and lymph-radiomic prognostic indexes capable of predicting OS and the benefits of PORT for patients with NSCLC.
Collapse
Affiliation(s)
- Zeliang Ma
- Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Men
- Department of VIP Medical Services, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunsong Liu
- Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongxing Bao
- Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian Liu
- Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Yang
- Department of Medical Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Deng
- Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Luhua Wang
- Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhouguang Hui
- Department of VIP Medical Services, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
2
|
Jiang L, Meng X. Is there role of adjuvant radiotherapy after complete resection of locally advanced nonsmall cell lung cancer? Curr Opin Oncol 2024; 36:44-50. [PMID: 37865829 DOI: 10.1097/cco.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW This review aims to provide a timely and relevant overview of the role of postoperative radiotherapy (PORT) in completely resected stage IIIA-N2 nonsmall cell lung cancer (NSCLC). Given the controversy surrounding the use of PORT and the emergence of advanced radiation techniques and therapies, this review provides valuable insight into current and potential treatment strategies. RECENT FINDINGS The Lung ART and PORT-C trials have provided valuable insights into the efficacy of PORT in stage IIIA-N2 NSCLC. While the results have been mixed, studies have shown that advanced radiation techniques, such as intensity-modulated radiotherapy (IMRT) and proton therapy, can reduce cardiopulmonary toxicities associated with PORT. Molecular targeted therapies and immunotherapies have also shown potential in improving NSCLC treatment outcomes. SUMMARY The role of radiotherapy becomes smaller and smaller in new era. However, it is too early to abolish radiotherapy for all the patients after complete resection of locally advanced NSCLC. Nowadays, it is recommended to adopt individualized treatment approaches guided by multidisciplinary team consultations. The integration of IMRT, proton therapy, and emerging therapies offers the potential to enhance treatment efficacy while minimizing toxicity. Further research is needed to optimize the use of PORT and explore the method to identify the patients who can really benefit from PORT.
Collapse
Affiliation(s)
- Liyang Jiang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | | |
Collapse
|
3
|
Wang L, Chen W, Xu X, Chen W, Bao D, Zhang Y, Xu Y. Effect of postoperative radiotherapy on survival in patients with completely resected and pathologically confirmed stage N2 non-small-cell lung cancer: a systematic review and meta-analysis. Ther Adv Chronic Dis 2023; 14:20406223231195622. [PMID: 37720592 PMCID: PMC10501070 DOI: 10.1177/20406223231195622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/02/2023] [Indexed: 09/19/2023] Open
Abstract
Background The role of postoperative radiotherapy (PORT) for patients with completely resected stage N2 non-small-cell lung cancer (NSCLC) has been controversial. This study aimed to investigate the efficacy of PORT and prognosis in these patients. Objectives An updated meta-analysis was conducted in this study to investigate the efficacy of PORT and prognosis in patients with completely resected and pathologically confirmed stage N2 NSCLC. Design This study is a systematic review and meta-analysis. Data source and methods Databases were searched up to 2 March 2022. All trials on patients with completely resected and pathologically confirmed stage N2 NSCLC undergoing PORT were screened, and data indicators in the PORT and non-PORT groups were extracted, respectively. The effect of PORT on overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) was estimated. Subgroup and sensitivity analyses were performed. Results In all, 20 studies involving 6340 patients were finally included. The PORT significantly increased OS [hazard ratio (HR) = 0.77, 95% CI: 0.71-0.84, p < 0.001), LRFS (HR = 0.63, 95% CI: 0.52-0.76, p < 0.001), and DFS (HR = 0.72, 95% CI: 0.63-0.82, p < 0.001) while it showed no significant difference in improving DMFS (HR = 0.86, 95% CI: 0.71-1.05, p = 0.14). Conclusion Our results suggest that in the postoperative treatment of patients with completely resected and pathologically confirmed stage N2 NSCLC, the addition of PORT provides better local recurrence control and survival benefit, but no benefit for distant metastases. The PORT may be incorporated into the postoperative treatment options for some patients with high-risk factors. However, it needs to be validated by more prospective studies in the future. Trail registration CRD42022314095.
Collapse
Affiliation(s)
- Lin Wang
- Department of Oncology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Wenyu Chen
- Department of Respiratory Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xiaofei Xu
- Department of Oncology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Wenbo Chen
- Department of Oncology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Derong Bao
- Department of Oncology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ye Zhang
- Department of General Medicine, Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Nanhu District, Jiaxing, Zhejiang 314001, China
| | - Yufen Xu
- Department of Oncology, Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Nanhu District, Jiaxing, Zhejiang 314001, China
| |
Collapse
|
4
|
Wu K, Peng W, Shuai Z, Peng X, Liu H, Zhang S. The impact of postoperative radiotherapy on the survival of patients with stage III non-small cell lung cancer: A CONSORT-compliant analysis using the SEER database. Medicine (Baltimore) 2023; 102:e34015. [PMID: 37327271 PMCID: PMC10270527 DOI: 10.1097/md.0000000000034015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/25/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Postoperative radiotherapy (PORT) is commonly used to treat patients with resected stage III non-small cell lung cancer (NSCLC), but its effectiveness remains uncertain. This retrospective cohort study aimed to investigate the impact of PORT on overall survival (OS) and evaluate its heterogeneity among subgroups of patients. METHODS A total of 6305 patients with resected stage III NSCLC were included in this study from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching was conducted to balance baseline characteristics between the patients who received PORT and those who did not. OS was used as the primary outcome. Subgroup analysis was performed to identify which patient subgroups might benefit more from PORT. RESULTS Overall, no significant difference was observed in OS between the 2 groups with or without propensity score matching. However, subgroup analysis demonstrated that PORT improved OS in patients with certain characteristics, including stage IIIA/N2, stage IIIB, squamous cell carcinoma, tumor grade III-IV, or lymph node ratio (LNR) > 1/3. Multivariate analysis showed that several variables were associated with adverse prognostic factors for OS, such as marital status (others), race (white), male gender, squamous cell carcinoma, elderly age, advanced stage, poor histological differentiation grade, high LNR, and not receiving chemotherapy. CONCLUSION In patients with resected stage III NSCLC, PORT may not be beneficial for all patients. However, it may improve survival time in certain patient subgroups, such as those with stage IIIA/N2, stage IIIB, squamous cell carcinoma, tumor grade III to IV, or LNR > 1/3. These findings provide important information for clinical decision-making and future research regarding the use of PORT in patients with resected stage III NSCLC.
Collapse
Affiliation(s)
- Kun Wu
- Department of Cardiothoracic Surgery, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Wang Peng
- School of Medical Equipment and Management, Xiangtan Medicine and Health Vocational College, Xiangtan, Hunan, China
| | - Zhifeng Shuai
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Xin Peng
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Haibo Liu
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Sanhong Zhang
- Department of Radiology, Liuyang Chinese Medicine Hospital, Changsha, Hunan, China
| |
Collapse
|
5
|
Zhou S, Zhai Y, Zhao K, Men Y, Meng X, Hui Z. Real world practice of postoperative radiotherapy for patients with completely resected pIIIA-N2 non-small cell lung cancer: a national survey of radiation oncologists in China. Radiat Oncol 2023; 18:17. [PMID: 36698150 PMCID: PMC9875489 DOI: 10.1186/s13014-023-02208-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Results from Lung ART and PORT-C trials suggest that postoperative radiotherapy (PORT) cannot routinely be recommended as standard treatment in completely resected pIIIA-N2 NSCLC patients, but their effects on the real-world practice of PORT in China remain unclear. METHODS A national cross-section survey was conducted by using an online survey service. Participants were voluntarily recruited using a river sampling strategy. A link to the survey was posted on websites of radiation oncologist associations and tweets from public WeChat accounts. The survey collected the real names of participants to ensure that they were board-certified radiation oncologists. RESULTS A total of 484 radiation oncologists were included with a median age of 40 years (IQR, 35-47). A total of 377 (77.9%) participants were male, and 282 (58.1%) had more than 10 years of clinical experience practicing thoracic radiotherapy. Before Lung ART and PORT-C trials were published, 313 (64.7%) respondents recommended PORT, 11 (2.3%) did not recommend it, and 160 (33.1%) reported that they made decisions based on risk factors. After the presentation of two trials, only 42 (8.7%) did not recommend PORT, while 108 (22.3%) recommended it, and 334 (69.0%) made decisions based on risk factors. The five most commonly considered risk factors among these 334 respondents were as follows: nodal extracapsular extension, the highest lymph node (LN) station involved, the number of dissected mediastinal LN stations, the number of positive mediastinal LN stations, and surgical approaches. In addition, the majority of all 484 respondents recommended a total dose of 50 Gy, lung stump + ipsilateral hilus + regions containing positive LNs as the targeted region, lung V20 < 25%, and heart V30 < 40% as dose constraints for PORT. CONCLUSION Most Chinese radiation oncologists recommended PORT for completely resected IIIA-N2 NSCLC patients based on risk factors, especially status of LN station.
Collapse
Affiliation(s)
- Shujie Zhou
- grid.440144.10000 0004 1803 8437Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, 250117 Shandong China
| | - Yirui Zhai
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Kaikai Zhao
- grid.440144.10000 0004 1803 8437Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yu Men
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China ,grid.506261.60000 0001 0706 7839Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Xiangjiao Meng
- grid.440144.10000 0004 1803 8437Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhouguang Hui
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China ,grid.506261.60000 0001 0706 7839Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| |
Collapse
|
6
|
Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer-A Review. Cancers (Basel) 2022; 14:cancers14071617. [PMID: 35406388 PMCID: PMC8997169 DOI: 10.3390/cancers14071617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/14/2022] [Accepted: 03/19/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The role of postoperative radiotherapy (PORT) in completely resected non-small cell lung cancer (NSCLC) with ipsilateral mediastinal lymph node involvement (pN2) is controversial. The aim of our review was to study the literature relating to PORT for completely resected NSCLC patients with pN2 involvement. The Lung ART and PORT-C trials indicate better locoregional control with PORT, but this has not yet translated into survival benefits. Given the conflicting results, guidelines do not recommend the use of PORT routinely. Future research should focus on identifying subgroups of patients who might benefit from PORT. Abstract Background: For patients with completely resected non-small cell lung cancer (NSCLC) with ipsilateral mediastinal lymph node involvement (pN2), the administration of adjuvant chemotherapy is the standard of care. The role of postoperative radiation therapy (PORT) is controversial. Methods: We describe the current literature focusing on the role of PORT in completely resected NSCLC patients with pN2 involvement and reflect on its role in current guidelines. Results: Based on the results of the recent Lung ART and PORT-C trials, the authors conclude that PORT cannot be generally recommended for all resected pN2 NSCLC patients. A substantial decrease in the locoregional relapse rate without translating into a survival benefit suggests that some patients with risk factors might benefit from PORT. This must be balanced against the risk of cardiopulmonary toxicity with potentially associated mortality. Lung ART has already changed the decision making for the use of PORT in daily practice for many European lung cancer experts, with lower rates of recommendations for PORT overall. Conclusions: PORT is still used, albeit decreasingly, for completely resected NSCLC with pN2 involvement. High-level evidence for its routine use is lacking. Further analyses are required to identify patients who would potentially benefit from PORT.
Collapse
|
7
|
Zhu L, Xia B, Ma S. Postoperative radiotherapy for patients with completely resected stage IIIA-N2 non-small cell lung cancer: opt-in or opt-out. Thorac Cancer 2022; 13:659-663. [PMID: 35106937 PMCID: PMC8888147 DOI: 10.1111/1759-7714.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
The role of adjuvant radiotherapy in completely resected pIIIA-N2 non-small cell lung cancer (NSCLC) has long been debated. Evidence from previous retrospective and prospective studies showed that postoperative radiotherapy could reduce the incidence of local recurrence and prolong disease-free survival, while two recently reported randomized controlled trials (lung ART and PORT-C) both demonstrated no survival benefit of postoperative radiotherapy. The great gap between our knowledge and reality has made us rethink the value of postoperative radiotherapy. In this mini review, we elaborate on the role of postoperative radiotherapy in completely resected pIIIA-N2 NSCLC.
Collapse
Affiliation(s)
- Lucheng Zhu
- Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bing Xia
- Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenglin Ma
- Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
8
|
Yamasaki N, Kim YH, Iwatsubo S, Nishimura Y, Funada Y. Role of Postoperative Radiotherapy in Patients With Completely Resected pIIIA-N2 Non-Small Cell Lung Cancer. Clin Lung Cancer 2021; 23:e171-e172. [PMID: 34756510 DOI: 10.1016/j.cllc.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Nanami Yamasaki
- Department of Respiratory Medicine, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Takatsuki General Hospital, Takatsuki, Osaka, Japan.
| | - Shigeaki Iwatsubo
- Department of Respiratory Medicine, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Yoshihiro Nishimura
- Department of Respiratory Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yasuhiro Funada
- Department of Respiratory Medicine, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| |
Collapse
|