术后放疗在接受新辅助化疗联合手术切除的非小细胞肺癌的应用进展

doi:10.3760/cma.j.cn113030-20200601-00288

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Abstract Neoadjuvant chemotherapy followed by surgery (NCS) is a common therapy pattern of non-small cell lung cancer (NSCLC). However, patients treated with NCS still suffer from relatively high locoregional recurrence. Postoperative radiotherapy (PORT) plays an important role in improving locoregional control, whereas its effect on survival remains controversial. Some studies propose that PORT yields no survival benefits for stage Ⅱ-ⅢA(N2) patients treated with NCS, whereas other researches indicate that PORT can bring survival benefits for high-risk patients. The indications of PORT include R1/R2 resection and ypN2. PORT is recommended with three-dimensional conformal therapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) within the dose range of 50-54Gy (R0 resection). The target volume is inconclusive and the irradiation range of mediastinum involving with the metastatic lymph node regions is recommended in many studies.The adverse effects of PORT are acceptable in most studies.Nevertheless, the evidence level of relevant studies is relatively low. These results remain to be clarified by prospective randomized clinical trials.

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	Articles by authors
	Bao Yongxing
	Hui Zhouguang

Key words： Carcinoma, non-small cell lung/postoperative radiotherapy Carcinoma, non-small cell lung/neoadjuvant chemotherapy Research progress

Received: 01 June 2020

Fund:National Key R&D Program of China (2017YFC1311000); Clinical Application Project of Beijing Municipal Commission of Science and Technology (Z171100001017114); CAMS Key lab of translational research on lung cancer (2018PT31035); Ministry of Education Innovation Team development project (IRT-17R10)

Corresponding Authors: Hui Zhouguang, Email:drhuizg@163.com

Cite this article:

Bao Yongxing,Hui Zhouguang. Postoperative radiotherapy for non-small cell lung cancer treated with neoadjuvant chemotherapy followed by surgery[J]. Chinese Journal of Radiation Oncology, 2022, 31(1): 90-96.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20200601-00288 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2022/V31/I1/90

[1] National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN Guidelines®)、non-small cell lung cancer version 3.2020. Fort Washington:NCCN, 2020[EB/OL][2020-02-11].https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.
[2] BILLIET C, PEETERS S, DECALUWWÉHH, et al. Postoperative radiotherapy for lung cancer:Is it worth the controversy?[J]. Cancer Treat Rev, 2016, 51:10-18. DOI:10.1016/j.ctrv.2016.10.001.
[3] DAI H, HUI Z, JI W, et al. Postoperative radiotherapy for resected pathological stage ⅢA-N2 non-small cell lung cancer:a retrospective study of 221 cases from a single institution[J]. Oncologist, 2011, 16(5):641-650. DOI:10.1634/theoncologist.2010-0343.
[4] PORT Meta-analysis Trialists Group. Postoperative radiotherapy in non-small-cell lung cancer:systematic review and meta-analysis of individual patient data from nine randomised controlled trials[J]. Lancet, 1998, 352(9124):257-263. DOI:10.1016/S0140-6736(98)06341-7.
[5] ROBINSON CG, PATEL AP, BRADLEY JD, et al. Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy:a review of the national cancer data base[J]. J Clin Oncol, 2015, 33(8):870-876. DOI:10.1200/JCO.2014.58.5380.
[6] ZENG WQ, FENG W, XIE L, et al. Postoperative radiotherapy for resected stage ⅢA-N2 non-small-cell lung cancer:a population-based time-trend study[J]. Lung, 2019, 197(6):741-751. DOI:10.1007/s00408-019-00284-7.
[7] 孙鑫,门玉,惠周光.ⅢA-N2期非小细胞肺癌新辅助治疗的研究现状[J]. 中华放射肿瘤学杂志, 2020, 29(1):61-64. DOI:10.3760/cma.j.issn.1004-4221.2020.01.014.
SUN X, MEN Y, HUI ZG. Research progress on neoadjuvant therapy in stage ⅢA-N2non-small cell lung cancer[J]. Chin J Radiat Oncol, 2020,29(1):61-64. DOI:10.3760/cma.j.issn.1004-4221.2020.01.014.
[8] BOGART JA, ARONOWITZ JN. Localized non-small cell lung cancer:adjuvant radiotherapy in the era of effective systemic therapy[J]. Clin Cancer Res, 2005, 11(13 Pt 2):5004s-5010s. DOI:10.1158/1078-0432. CCR-05-9010.
[9] BETTICHER DC, HSU-SCHMITZ SF,TÖTSCH M, et al. Prognostic factors affecting long-term outcomes in patients with resected stage ⅢA pN2 non-small-cell lung cancer:5-year follow-up of a phase Ⅱ study[J]. Br J Cancer, 2006, 94(8):1099-1106. DOI:10.1038/sj.bjc.6603075.
[10] LEWIS J, GILLASPIE EA, OSMUNDSON EC, et al. Before or after:evolving neoadjuvant approaches to locally advanced non-small cell lung cancer[J]. Front Oncol, 2018, 8:5. DOI:10.3389/fonc.2018.00005.
[11] NSCLC Meta-analysis Collaborative Group. Preoperative chemotherapy for non-small-cell lung cancer:a systematic review and meta-analysis of individual participant data[J]. Lancet, 2014, 383(9928):1561-1571. DOI:10.1016/S0140-6736(13)62159-5.
[12] THOMAS M,RÜBE C, HOFFKNECHT P, et al. Effect of preoperative chemoradiation in addition to preoperative chemotherapy:a randomised trial in stage Ⅲ non-small-cell lung cancer[J]. Lancet Oncol, 2008, 9(7):636-648. DOI:10.1016/S1470-2045(08)70156-6.
[13] GILLASPIE EA, WIGLE DA. Management of stage ⅢA(N2) non-small cell lung cancer[J]. Thorac Surg Clin, 2016, 26(3):271-285. DOI:10.1016/j.thorsurg.2016.04.001.
[14] MARTINI N, KRIS MG, FLEHINGER BJ, et al. Preoperative chemotherapy for stage ⅢA(N2) lung cancer:the Sloan-Kettering experience with 136 patients[J]. Ann Thorac Surg, 1993, 55(6):1365-1374. DOI:10.1016/0003-4975(93)91072-u.
[15] SUGARBAKER DJ, HERNDON J, KOHMAN LJ, et al. Results of cancer and leukemia group B protocol 8935. A multⅡnstitutional phase Ⅱ trimodality trial for stage ⅢA(N2) non-small-cell lung cancer. Cancer and leukemia group B thoracic surgery group[J]. J Thorac Cardiovasc Surg, 1995, 109(3):473-485. DOI:10.1016/s0022-5223(95)70278-4.
[16] ELIAS AD, SKARIN AT, LEONG T, et al. Neoadjuvant therapy for surgically staged ⅢA N2 non-small cell lung cancer (NSCLC)[J]. Lung Cancer (Amsterdam, Netherlands), 1997, 17(1):147-161. DOI:10.1016/s0169-5002(97)00658-2.
[17] ROSELL R,,GÕMEZ-CODINA J, CAMPS C, et al. Preresectional chemotherapy in stage ⅢA non-small-cell lung cancer:a 7-year assessment of a randomized controlled trial[J]. Lung Cancer, 1999, 26(1):7-14. DOI:10.1016/s0169-5002(99)00045-8.
[18] DEPIERRE A, MILLERON B, MORO-SIBILOT D, et al. Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage Ⅰ (except T1N0), Ⅱ, and ⅢA non-small-cell lung cancer[J]. J. Clin. Oncol, 2002, 20(1):247-253. DOI:10.1200/JCO.2002.20.1.247.
[19] CAPPUZZO F, SELVAGGI G, GREGORC V, et al. Gemcitabine and cisplatin as induction chemotherapy for patients with unresectable stage ⅢA-bulky N2 and stage ⅢBnonsmall cell lung carcinoma:an Italian lung cancer project observational study[J]. Cancer, 2003, 98(1):128-134. DOI:10.1002/cncr.11460.
[20] DE MARINIS F, NELLI F, MIGLIORINO MR, et al. Gemcitabine, paclitaxel, and cisplatin as induction chemotherapy for patients with biopsy-proven StageⅢA(N2) nonsmall cell lung carcinoma:a Phase Ⅱ multicenter study[J]. Cancer, 2003, 98(8):1707-1715. DOI:10.1002/cncr.11662.
[21] CHAFT JE, RUSCH V, GINSBERG MS, et al. Phase Ⅱ trial of neoadjuvant bevacizumab plus chemotherapy and adjuvant bevacizumab in patients with resectablenonsquamous non-small-cell lung cancers[J]. J Thorac Oncol, 2013, 8(8):1084-1090. DOI:10.1097/JTO.0b013e31829923ec.
[22] MANTOVANI C, LEVRA NG, FILIPPI AR, et al. Postoperative radiotherapy for patients with completely resected pathologic n2 non-small-cell lung cancer:a retrospective analysis[J]. Clin. Lung Cancer, 2013, 14(2):194-199. DOI:10.1016/j.cllc.2012.05.007.
[23] ASKOXYLAKIS V, TANNER J, KAPPES J, et al. Trimodal therapy for stage Ⅲ-N2 non-small-cell lung carcinoma:a single center retrospective analysis[J]. BMC Cancer, 2014, 14:572. DOI:10.1186/1471-2407-14-572.
[24] TAYLOR NA, LIAO ZX, STEVENS C, et al. Postoperative radiotherapy increases locoregional control of patients with stage ⅢA non-small-cell lung cancer treated with induction chemotherapy followed by surgery[J]. Int J Radiat Oncol, 2003, 56(3):616-625. DOI:10.1016/s0360-3016(03)00063-4.
[25] MATSUGUMA H, NAKAHARA R, ISHIKAWA Y, et al. Postoperative radiotherapy for patients with completely resected pathological stage ⅢA-N2 non-small cell lung cancer:focusing on an effect of the number of mediastinal lymph node stations involved[J]. Interact Cardiovasc Thorac Surg, 2008, 7(4):573-577. DOI:10.1510/icvts.2007.174342.
[26] KIM BH, KIM HJ, WU HG, et al. Role of postoperative radiotherapy after curative resection and adjuvant chemotherapy for patients with pathological stage N2 non-small-cell lung cancer:a propensity score matching analysis[J]. Clin Lung Cancer, 2014, 15(5):356-364. DOI:10.1016/j.cllc.2014.05.005.
[27] BILLIET C, PEETERS S, DECALUWÉH, et al. Outcome after PORT in ypN2 or R1/R2 versus no PORT in ypN0 stage Ⅲ-N2 NSCLC after induction chemotherapy and resection[J]. J Thorac Oncol, 2016, 11(11):1940-1953. DOI:10.1016/j.jtho.2016.06.018.
[28] SHEPHERD A, GELBLUMD, WU A, et al. The role of post-operative radiation therapy in patients with locally advanced NSCLC after nodal downstaging with systemic chemotherapy[C]. Toronto:IASLC 19^th World Conference on Lung Cancer, 2018.
[29] BRANDT WS, YAN W, LEEMAN JE, et al. Postoperative radiotherapy for surgically resected ypN2 non-small cell lung cancer[J]. Ann Thorac Surg, 2018, 106(3):848-855. DOI:10.1016/j.athoracsur.2018.04.064.
[30] SHINDE A, HORNE ZD, LI R, et al. Optimal adjuvant therapy in clinically N2 non-small cell lung cancer patients undergoing neoadjuvant chemotherapy and surgery:the importance of pathological response and lymph node ratio[J]. Lung Cancer (Amsterdam, Netherlands), 2019, 133:136-143. DOI:10.1016/j.lungcan.2019.05.020.
[31] BAO Y,J. Kang, Y. Men, et al. Patients with ypN2 NSCLC after neoadjuvant chemotherapy followed by surgery can benefit from PORT–a retrospective study of seer database[C]. Barcelona:IASLC 20^th World Conference on Lung Cancer, 2019.
[32] ZHAO Y, WANG W, LIANG H, et al. The optimal treatment for stage ⅢA-n2 non-small cell lung cancer:a network Meta-analysis[J]. Ann Thorac Surg, 2019, 107(6):1866-1875. DOI:10.1016/j.athoracsur.2018.11.024.
[33] TSUNEZUKA H, INOUE M. Treatment rationale and design of the induction chemotherapy and adjuvant thoracic radiation in resectable N2-3A/3B non-small cell lung cancer (ICAT) study[J]. Medicine (Baltimore), 2019, 98(27):e16298-e16298. DOI:10.1097/MD.0000000000016298.
[34] 邓垒,惠周光,门玉,等. 术前临床因素预测pⅢA-N2非小细胞肺癌术后放疗获益人群的研究[J]. 国际放射医学核医学杂志,2018, 42(3):224-232. DOI:10.3760/cma.j.issn.1673-4114.2018.03.006.
DENG L, HUI ZG, MEN Y,et al. Preoperative clinical risk factors in selecting patients with pathological ⅢA-N2 non-small-cell lung cancer benefiting from postoperative radiotherapy[J]. Int J Radiat Med Nucl Med, 2018,42(3):224-232. DOI:10.3760/cma.j.issn.1673-4114.2018.03.006.
[35] WANG EH, CORSO CD, RUTTER CE, et al. Postoperative radiation therapy is associated with improved overall survival in incompletely resected stage Ⅱ and Ⅲ non-small-cell lung cancer[J]. J Clin Oncol, 2015, 33(25):2727-2734. DOI:10.1200/JCO.2015.61.1517.
[36] KAMEL MK, RAHOUMA M, GHALY G, et al. Clinical predictors of persistent mediastinal nodal disease after induction therapy for stage ⅢA-N2 non-small cell lung cancer[J]. Ann Thorac Surg, 2017, 103(1):281-286. DOI:10.1016/j.athoracsur.2016.06.061.
[37] PAUMIER A, LEPÉCHOUX C. Post-operative radiation therapy[J]. Transl Lung Cancer Res, 2013, 2(5):423-432. DOI:10.3978/j.issn.2218-6751.2013.10.03.
[38] BILLIET C, DECALUWÉH, PEETERS S, et al. Modern post-operative radiotherapy for stage Ⅲ non-small cell lung cancer may improve local control and survival:a meta-analysis[J]. Radiother Oncol, 2014, 110(1):3-8. DOI:10.1016/j.radonc.2013.08.011.
[39] CORSO CD, RUTTER CE, WILSON LD, et al. Re-evaluation of the role of postoperative radiotherapy and the impact of radiation dose for non-small-cell lung cancer using the National Cancer Database[J]. J. Thorac. Oncol, 2015, 10(1):148-155. DOI:10.1097/JTO.0000000000000406
[40] MILES EF, KELSEY CR, KIRKPATRICK JP, et al. Estimating the magnitude and field-size dependence of radiotherapy-induced mortality and tumor control after postoperative radiotherapy for non-small-cell lung cancer:calculations from clinical trials[J]. Int J Radiat Oncol Biol Phys, 2007, 68(4):1047-1052. DOI:10.1016/j.ijrobp.2007.02.028.
[41] FORDE PM, CHAFT JE, SMITH KN, et al. Neoadjuvant PD-1 blockade in resectable lung cancer[J]. New Engl J Med, 2018, 378(21):1976-1986. DOI:10.1056/NEJMoa1716078.
[42] ZHONG WZ, CHEN KN, CHEN C, et al. Erlotinib versus gemcitabine plus cisplatin as neoadjuvant treatment of stage ⅢA-N2 EGFR-mutant non-small-cell lung cancer (EMERGING-CTONG 1103):a randomized phase Ⅱ study[J]. J Clin Oncol, 2019, 37(25):2235-2245. DOI:10.1200/JCO.19.00075.
[43] RABBANI M, KANEVSKY J, KAFI K, et al. Role of artificial intelligence in the care of patients with nonsmall cell lung cancer[J]. Eur J Clin Invest, 2018, 48(4):e12901. DOI:10.1111/eci.12901.
[44] HOSNY A, PARMAR C, COROLLER T P, et al. Deep learning for lung cancer prognostication:a retrospective multi-cohort radiomics study[J]. PLoS Med, 2018, 15(11):e1002711. DOI:10.1371/journal.pmed.1002711.