J Korean Soc Ther Radiol Oncol.  2009 Sep;27(3):126-132. 10.3857/jkstro.2009.27.3.126.

Division of the N2 Stage According to the Multiplicity of the Involved Nodal Stations May be Necessary in the N2-NSCLC Patients Who are Treated with Postoperative Radiotherapy

• Yoon HI
• Kim YB
• Lee CG
• Lee IJ
• Kim S
• Kim JW
• Kim JH
• Cho BC
• Lee JG
• Chung KY

• KMID: 2097240
• DOI: http://doi.org/10.3857/jkstro.2009.27.3.126

Abstract

PURPOSE
We wanted to evaluate the prognostic factors for the pathologic N2 non-small cell lung cancer (NSCLC) patients who were treated by postoperative radiotherapy.
MATERIALS AND METHODS
We retrospectively reviewed 112 pN2 NSCLC patients who underwent surgery and postoperative radiotherapy (PORT) From January 1999 to February 2008. Seventy-five (67%) patients received segmentectomy or lobectomy and 37 (33%) patients received pneumonectomy. The resection margin was negative in 94 patients, and it was positive or close in 18 patients. Chemotherapy was administered to 103 (92%) patients. Nine (8%) patients received PORT alone. The median radiation dose was 54 Gy (range, 45 to 66), and the fraction size was 1.8~2 Gy.
RESULTS
The 2-year overall survival (OS) rate was 60.2% and the disease free survival (DFS) rate was 44.7% for all the patients. Univariate analysis showed that the patients with multiple-station N2 disease had significantly reduced OS and DFS (p=0.047, p=0.007) and the patients with an advanced T stage (> or =T3) had significantly reduced OS and DFS (p<0.001, p=0.025). A large tumor size (> or =5 cm) and positive lymphovascular invasion reduced the OS (p=0.035, 0.034). Using multivariate analysis, we found that multiple-station N2 disease and an advanced T stage (> or =T3) significantly reduced the OS and DFS. Seventy one patients (63.4%) had recurrence of disease. The patterns of failure were loco-regional in 23 (20.5%) patients, distant failure in 62 (55.4%) and combined loco-regional and distant failure in 14 (12.5%) patients.
CONCLUSION
Multiple involvement of mediastinal nodal stations for the pN2 NSCLC patients with PORT was a poor prognostic factor in this study. A prospective study is necessary to evaluate the N2 subclassification and to optimize the adjuvant treatment.

Keyword

Non-small cell lung cancer; Mediastinal nodal metastasis; Postoperative radiotherapy; Multiple station involvement

MeSH Terms

Carcinoma, Non-Small-Cell Lung
Disease-Free Survival
Humans
Mastectomy, Segmental
Multivariate Analysis
Pneumonectomy
Recurrence
Retrospective Studies