Purpose: Our institution has executed two different kinds of adjuvant protocols in treating patients with non-small cell lung cancer (NSCLC): 1) chemotherapy followed by concurrent chemoradiotherapy (CTx-CCRT) and 2) sequential postoperative radiotherapy (PORT) followed by postoperative chemotherapy (POCT) (i.e. RT-CT). This study is targeted to compare the clinical outcomes between the two adjuvant protocols.
Materials and Methods: From March 1997 to October 2012, 68 patients were treated with CTx-CCRT (n = 25) and RT-CT (n = 43). The CTx-CCRT protocol consisted of 2 cycles of cisplatin-based POCT followed by PORT concurrently with 2 cycles of POCT. The RT-CT protocol consisted of PORT followed by 4 cycles of cisplatin-based POCT. PORT was implemented with conventional fractionations of 50.4 – 60 Gy dose. We compared the outcomes between the two adjuvant protocols and studied about the clinical factors affecting survivals.
Results: Median follow-up time was 43.9 months (range 3.2 – 74.0), and the 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were 53.9%, 68.2%, and 51.0%, respectively. There were no significant differences in OS (p = 0.074), LRFS (p = 0.094), and DMFS (p = 0.490) between the two protocols. In multivariable analyses, adjuvant protocol remained as a significant prognostic factor for LRFS, favouring CTx-CCRT (HR = 3.506, p = 0.046) over RT-CT, not for OS (HR = 0.647, p = 0.229).
Conclusions: CTx-CCRT protocol increased LRFS more than RT-CT protocol in patients with completely resected NSCLC, but not in OS. Further studies are warranted to evaluate the benefit of CTx-CCRT strategy compared with sequential strategy.
