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Role of Postoperative Radiotherapy in the Management for Resected NSCLC - Decision Criteria in Clinical Routine Pre- and Post-LungART

Krisztian Süveg, Cecile Le Pechoux, Corinne Faivre-Finn, Paul Martin Putora, Dirk De Ruysscher, Joachim Widder, Paul Van Houtte, Esther G C Troost, Ben J Slotman, Sara Ramella, Christoph Pöttgen, Stephanie T H Peeters, Ursula Nestle, Fiona McDonald, Rafal Dziadziuszko, José Belderbos, Umberto Ricardi, Farkhad Manapov, Yolande Lievens, Xavier Geets, Karin Dieckmann, Matthias Guckenberger, Nicolaus Andratschke & Markus Glatzer

abstract

BACKGROUND
The role of postoperative radiation therapy (PORT) in stage III N2 NSCLC is controversial. We analyzed decision-making for PORT among European radiation oncology experts in lung cancer.

METHODS
Twenty-two experts were asked before and after presentation of the results of the LungART trial to describe their decision criteria for PORT in the management of pN+ NSCLC patients. Treatment strategies were subsequently converted into decision trees and analyzed.

RESULTS
Following decision criteria were identified: extracapsular nodal extension, incomplete lymph node resection, multistation lymph nodes, high nodal tumor load, poor response to induction chemotherapy, ineligibility to receive adjuvant chemotherapy, performance status, resection margin, lung function and cardiopulmonary comorbidities. The LungART results had impact on decision-making and reduced the number of recommendations for PORT. The only clear indication for PORT was a R1/2 resection. Six experts out of ten who initially recommended PORT for all R0 resected pN2 patients no longer used PORT routinely for these patients, while four still recommended PORT for all patients with pN2. Fourteen experts used PORT only for patients with risk factors, compared to eleven before the presentation of the LungART trial. Four experts stated that PORT was never recommended in R0 resected pN2 patients regardless of risk factors.

CONCLUSION
After presentation of the LungART trial results at ESMO 2020, 82% of our experts still used PORT for stage III pN2 NSCLC patients with risk factors. The recommendation for PORT decreased, especially for patients without risk factors. Cardiopulmonary comorbidities became more relevant in the decision-making for PORT.
   
citation Süveg K, Le Pechoux C, Faivre-Finn C, Putora P M, De Ruysscher D, Widder J, Van Houtte P, Troost E G C, Slotman B J, Ramella S, Pöttgen C, Peeters S T H, Nestle U, McDonald F, Dziadziuszko R, Belderbos J, Ricardi U, Manapov F, Lievens Y, Geets X, Dieckmann K, Guckenberger M, Andratschke N, Glatzer M. Role of Postoperative Radiotherapy in the Management for Resected NSCLC - Decision Criteria in Clinical Routine Pre- and Post-LungART. Clin Lung Cancer 2021; 22:579-586.
   
type journal paper/review (English)
date of publishing 14-08-2021
journal title Clin Lung Cancer (22/6)
ISSN electronic 1938-0690
pages 579-586
PubMed 34538585
DOI 10.1016/j.cllc.2021.08.007