Deal or node-eal?

Top Line: Does post-operative radiation (PORT) improve disease-free survival in patients with N2 non-small cell lung cancer?

The Study: Adjuvant radiation for resected, but node-positive NSCLC is a complicated matter. Previous data suggests possible detriment in patients with N1 disease and benefit in patients with N2 disease. We’ve all been waiting around for results of the LungART trial, and here they are presented in abstract form at ESMO 2020. LungART took patients with resected (R0) NSCLC and pathologically positive N2 nodes after surgery and randomized them to receive post-op RT (PORT, 54 Gy in 27-30 fractions) or no PORT. The goal was to see if PORT improved disease-free survival from 30→ 42% at 3 years. The PORT target included the ipsilateral bronchial stump and hilum, the involved nodal stations, and any stations in-between. The majority of patients were staged with PET/CT, had adenocarcinoma, and received chemotherapy. At 3 years, there was no significant difference in DFS (47.1% with PORT, 43.8% without, and both higher than expected). Median DFS was 30.5 and 22.8 months, respectively. The problem was that even though PORT slashed the rate of mediastinal recurrence (46→ 25%), those mediastinal recurrences were rarely isolated. We’ll look forward to the full manuscript to look at recurrence patterns and cardiopulmonary toxicity with PORT. 

TBL: PORT for resected, N2 NSCLC reduced the risk of mediastinal recurrence by an absolute 20%, but there wasn’t a significant improvement in disease-free survival. | Le Pechoux, ESMO 2020