Long-term Efficacy And Prognostic Factors Of Different Radiochemotherapy Models In PN2-stage Lung Adenocarcinoma Patients After Surgery

Objective:To explore the clinical efficacy and safety of concurrent chemoradiotherapy(cCRT)and sequential chemoradiotherapy(sCRT)in pN2-stage lung adenocarcinoma patients after surgery,and to analyze the related influencing factors.Methods:Collecting patients with stage ?A-N2 lung adenocarcinoma admitted to the Clinical Cancer Center of Hospital from January 1,2014 to December 31,2016.After being randomly divided into two groups,and treated with pemetrexed/cisplatin concurrent or sequential intensity modulated radiation therapy(IMRT)respectively.Every 3 weeks is a chemotherapy cycle,we need to observe the prognosis and treatment-related toxicities of the two groups of subjects.SPSS software was used to analyze the data and find relevant influencing factors.Results:A total of 62 patients were enrolled in the study.They were divided into two groups by random number table method.Of these,31 received concurrent chemoradiotherapy and 31 underwent sequential chemoradiotherapy.There were no significant differences in the clinical data and pathological features between the subjects in terms of age,gender,smoking status,primary tumor size,tumor differentiation degree,and pre-treatment physical status score(ECOG performance status)(P > 0.05).The data ratio is balanced.The median disease free survival(mDFS)was 16.230 months(95% CI= 14.953 to 17.507)in the cCRT,and the median DFS was 15.433 months(95% CI= 11.983 to 18.884)in the sCRT.There was no significant difference in median DFS between the two groups(P= 0.324> 0.05).The median overall survival(OS)among the cCRT and the sCRT groups in patients were 24.133 months(95% CI= 20.478 to 27.789)versus 25.900 months(95% CI= 19.636 to 32.164),no differences in mOS were seen in the two groups(P = 0.514 > 0.05).Multivariate analysis showed that the stage of primary tumor(P = 0.003)and predicted value of FEV1% before treatment(P = 0.001)were independent factors of DFS.The T stage lesions(P = 0.040)was an independent factor of OS.The risk of death in patients with T1 stage was lower than that in patients with T2-3,HR=1.896(95% CI= 1.029 to 3.493).In the treatment-related toxicity,such as hematological toxicity,liver and kidney dysfunction,gastrointestinal toxicity,etc.,there was no obvious difference between the synchronous group and the sequential group(P> 0.05).However,the incidence of radiation pneumonitis above grade 2 in the synchronous treatment group was higher than that in the sequential treatment group(P = 0.030 < 0.05).Different modes of radiochemotherapy(P = 0.024 < 0.05)and FEV1% predicted value before treatment were significantly correlated with radiation pneumonitis(P = 0.025 < 0.05),which were the influencing factors of radiation pneumonia.Conclusions:There was no difference in DFS and OS of the cCRT and sCRT groups in patients with stage ?A-N2 lung adenocarcinoma.However,the incidence of radiation pneumonitis above grade 2 in the sCRT population was lower than that in cCRT.The treatment pattern and FEV1% predicted value are factors influencing the occurrence of radiation pneumonitis in patients.Predicted value of FEV1% and T stage are the influencing factors of DFS,and tumor T stage is the influencing factors of OS.Sequential chemoradiotherapy is an option for patients with poor general condition.