[Postoperative radiotherapy in non-small cell lung cancer stage IIIA - N2: Focus and perspectives].
Pascal Wang, Boris Duchemann, Kader Chouahnia, Lise Matton, Ambre Benabadji, Laurent Zelek, Hosni Popotte, Adrien Paix
Author Information
Pascal Wang: Assistance publique-Hôpitaux de Paris (AP-HP), Avicenne Hospital, service d'oncologie médicale et thoracique, Bobigny, France; Institut de radiothérapie de Bobigny - Ramsay Santé, rue Lautréamont, 93000 Bobigny, France.
Boris Duchemann: Assistance publique-Hôpitaux de Paris (AP-HP), Avicenne Hospital, service d'oncologie médicale et thoracique, Bobigny, France; Gustave-Roussy Cancer Campus, laboratoire d'immunomonitoring en oncologie, CNRS-UMS 3655, Inserm-US23, 94805 Villejuif, France.
Kader Chouahnia: Assistance publique-Hôpitaux de Paris (AP-HP), Avicenne Hospital, service d'oncologie médicale et thoracique, Bobigny, France.
Lise Matton: Assistance publique-Hôpitaux de Paris (AP-HP), Avicenne Hospital, service d'oncologie médicale et thoracique, Bobigny, France.
Ambre Benabadji: Assistance publique-Hôpitaux de Paris (AP-HP), Avicenne Hospital, service d'oncologie médicale et thoracique, Bobigny, France.
Laurent Zelek: Assistance publique-Hôpitaux de Paris (AP-HP), Avicenne Hospital, service d'oncologie médicale et thoracique, Bobigny, France.
Hosni Popotte: Institut de radiothérapie de Bobigny - Ramsay Santé, rue Lautréamont, 93000 Bobigny, France; Assistance publique, Hôpitaux de Paris (AP-HP), Hôpital Tenon, service d'oncologie radiothérapie, Paris, France.
Adrien Paix: Institut de radiothérapie de Bobigny - Ramsay Santé, rue Lautréamont, 93000 Bobigny, France. Electronic address: a.paix@ramsaygds.fr.
Patients with resectable stage IIIA - N2 lung cancer represent a very heterogeneous population with variable risks of postoperative recurrence depending on the type of N2 involvement (unisite N2, multisite N2, bulky N2, extra-capsular rupture, incomplete resection…). This heterogeneity associated with the difficulty of carrying out prospective randomized studies with sufficient power in stages IIIA - 2, results in the absence of clear and consensual recommendations (except for stages IIIA - N2 resectable R0, since LungART and PORT-C studies). The objective of this article is to make an update on the place of postoperative radiotherapy in the management of stages IIIA - N2 following the publication of two recent randomized trials (PORT-C and LungART) but also compare them fort a better understanding of the current issues raised by these first published results. Indeed, these two trials do not find any benefit in terms of progression free survival and overall survival of postoperative radiotherapy but exploratory analyzes from these two studies seem to show a potential benefit of postoperative in some pN2 populations at high risk of locoregional recurrence (N2 multisite, N2 bulky…). In addition, the advent of immunotherapy (atezolizumab or pembrolizumab) and targeted therapies (osimertinib) in the adjuvant situation are redebating the place of a possible indication for postoperative radiotherapy in stage IIIA - 2.
