According to a study published in the Journal of Clinical Oncology, adjuvant chemotherapy administered prior to, rather than concurrently with, radiotherapy improves survival outcomes among patients with non–small cell lung cancer (NSCLC) with negative margins post-resection and pN2 disease.1

Data from previous studies suggest that adjuvant chemotherapy and postoperative radiotherapy (PORT) may improve patient outcomes, but the optimal sequence of administration was previously unestablished.

For this study, researchers accessed the National Cancer Database to identify and assign patients with non-metastatic NSCLC who had undergone resection, multi-agent chemotherapy, and radiotherapy, to 1 of 2 cohorts: cohort 1 included 727 patients with R0 resection and pN2 disease; cohort 2 included 277 patients with R1-2 resection with any nodal status. The authors compared the overall survival (OS) outcomes of patients who received chemoradiotherapy (CRT) concurrently with the OS outcomes of those who received chemotherapy prior to PORT (C-PORT).

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After a median follow-up of 32.8 months, patients in cohort 1 who received CRT had a median OS of 40.4 months compared with 58.8 months among patients who received C-PORT (P < .001). Patients in cohort 1 who received C-PORT had an improved OS even after propensity score matching vs CRT (hazard ratio [HR], 1.35; P = .019).

The median follow-up for cohort 2 was 27.9 months. Median OS was 38.5 months for CRT patients vs 42.6 months for C-PORT patients (P = .42). Propensity score matching revealed no significant difference in OS between CRT and C-PORT patients (HR, 1.35; P = .19).

The authors concluded that “in the postoperative setting for patients with NSCLC with R0 resection and pN2 disease, sequential C-PORT was associated with improved OS compared with CRT. For patients with positive margins, there was not a clear association between treatment sequencing and survival.”


  1. Francis S, Orton A, Stoddard G, et al. Sequencing of postoperative radiotherapy and chemotherapy for locally advanced or incompletely resected non-small-cell lung cancer. J Clin Oncol. 2017 Dec 13. doi: 10.1200/JCO.2017.74.4771 [Epub ahead of print]