Quality of surgery and RT in stage IIIN2 NSCLC: Insights from the Lung Adjuvant Radiotherapy trial

Abstract

Purpose or Objective The objective of the phase III Lung Adjuvant Radiotherapy Trial (LungART) is to determine if modern conformal mediastinal postoperative radiotherapy (PORT), adapted to tumor location and involved lymph nodes (LN), can improve disease-free survival (DFS) for completely resected stage III N2 non-small-cell lung cancer (NSCLC) patients (pts). Given the potential toxicity of PORT in older randomized trials, it is crucial to investigate the quality assurance (QA) of both surgery and radiotherapy (RT). Material and Methods First, a surgical advisory committee composed of 4 expert thoracic surgeons reviews anonymized surgical and pathological reports, and establishes the quality of tumor resection and nodal exploration, taking into consideration the international guidelines. Then, for the RT QA analyses, RT advisory committee composed of 4 expert thoracic radiation oncologists, reassesses dosimetric plans of each patient treated in the PORT arm and correlates nodal target coverage with surgical data. Results In June 2019, from 252 patients treated in PORT arm, 142 files have already been analyzed for surgical and RT QA. Conclusion Despite the encouraging survival rates, similar or even better than those observed in the modern series of conventionally fractionated RT-CHT, the observed rate of toxic and probably toxic deaths that occurred within one year after treatment challenges the safety of the routine use of accelerated hypofractionated RT with concomitant full dose CHT.