Is there a place for postoperative chemoradiotherapy in the modern treatment of non-small cell lung cancer?
TL;DR
The level of evidence supporting the combined chemoradiotherapy approach is inferior to that for adjuvant chemotherapy, necessitating a selective strategy: radiotherapy should only be considered in cases when predictive models indicate a high likelihood of benefit.
Abstract
Non-small cell lung cancer is the leading cause of cancer death worldwide. Despite advances in diagnostics and treatment, the prognosis for patients with locally advanced disease, particularly with mediastinal lymph node-positive disease (pN2), remains poor. Adjuvant drug therapy has become the standard of care for many patients with stage IB–IIIA NSCLC following curative surgery, demonstrating improved overall survival. However, the role of postoperative radiation therapy (PORT), specifically combination chemoradiotherapy, in the adjuvant setting for patients with pN2 disease remains a subject of intense research and debate. Given the high heterogeneity of NSCLC and continually evolving treatment modalities, including the introduction of targeted therapies and immunotherapy, it is critical to reassess the optimal adjuvant treatment options for patients with non-small cell lung cancer. The aim of this study was to analyze the safety and efficacy of adjuvant chemoradiotherapy compared with adjuvant chemotherapy in patients with pN2 NSCLC after R0 resection, based on a review of current scientific publications. The aim of this study was to analyze the safety and efficacy of adjuvant chemoradiotherapy compared to adjuvant chemotherapy in patients with pN2 NSCLC after R0 resection, based on the study of current scientific publications. To conduct this comparative analysis, a systematic review of the current scientific literature published in peer-reviewed journals was performed using search queries for “non-small cell lung cancer,” “radical surgery,” and “postoperative radiotherapy.” The primary focus was on studies comparing adjuvant chemoradiotherapy and adjuvant chemotherapy in patients with stage pN2 NSCLC after radical surgery. Data analysis was performed considering overall survival, relapse-free survival, local control, and toxicity profiles. Particular attention was paid to identifying factors influencing the selection of the optimal strategy for individual patients. Given current international guidelines, the routine use of PORT in patients with pN2 NSCLC is not recommended. The level of evidence supporting the combined chemoradiotherapy approach is inferior to that for adjuvant chemotherapy, necessitating a selective strategy: radiotherapy should only be considered in cases when predictive models indicate a high likelihood of benefit. Keywords: non-small cell lung cancer, chemotherapy, radiation therapy, adjuvant chemoradiation therapy, mediastinal lymph node metastases.