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Response to Bao et al

Published:November 02, 2022DOI:https://doi.org/10.1016/j.radonc.2022.10.031
      We appreciate Bao et al. for their interest on our recently reported retrospective study regarding the use of postoperative radiotherapy (PORT) in patients with persistent N2 non-small cell lung cancer after neoadjuvant chemotherapy [
      • Bao Y.
      • Hui Z.
      Postoperative radiotherapy for ypN2 non-small cell lung cancer after neoadjuvant chemotherapy and surgery warrants further evaluation.
      ,
      • Komiya T.
      • Takamori S.
      • Wilding G.
      Adjuvant radiation therapy improves survival in stage IIIA (N2) non-small cell lung cancer with persistent N2 disease after neoadjuvant chemotherapy.
      ]. The role of PORT has been one of the controversial subjects in thoracic oncology for decades. Although the recent prospective phase III trials demonstrated lack of survival benefit in overall N2 population, the subgroup analysis of patients who have undergone neoadjuvant chemotherapy had a significantly longer disease-free survival in those with PORT [
      • Le Pechoux C.
      • Pourel N.
      • Barlesi F.
      • et al.
      Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial.
      ,
      • Hui Z.
      • Men Y.
      • Hu C.
      • et al.
      Effect of postoperative radiotherapy for patients with pIIIA-N2 Non-small cell lung cancer after complete resection and adjuvant chemotherapy. The phase 3 PORT-C randomized clinical trial.
      ]. A retrospective single institutional study also demonstrated that the use of PORT could significantly improve overall survival in this population [
      • Brandt W.S.
      • et al.
      Postoperative radiotherapy for surgically resected ypN2 non-small cell lung cancer.
      ]. A list of studies in this regard was nicely presented by Bao et al., suggesting that further investigation is needed. Now that neoadjuvant chemo-immunotherapy has become a standard management in clinical N2 disease, the use of PORT may play a role in those who do not achieve nodal downstage or pathologic complete response which are known poor prognostic factors.
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      References

        • Bao Y.
        • Hui Z.
        Postoperative radiotherapy for ypN2 non-small cell lung cancer after neoadjuvant chemotherapy and surgery warrants further evaluation.
        Radiother Oncol. 2002; https://doi.org/10.1016/j.radonc.2022.10.032
        • Komiya T.
        • Takamori S.
        • Wilding G.
        Adjuvant radiation therapy improves survival in stage IIIA (N2) non-small cell lung cancer with persistent N2 disease after neoadjuvant chemotherapy.
        Radiother Oncol. 2022; https://doi.org/10.1016/j.radonc.2022.07.018
        • Le Pechoux C.
        • Pourel N.
        • Barlesi F.
        • et al.
        Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial.
        LancetOncol. 2022; 23: 104-114
        • Hui Z.
        • Men Y.
        • Hu C.
        • et al.
        Effect of postoperative radiotherapy for patients with pIIIA-N2 Non-small cell lung cancer after complete resection and adjuvant chemotherapy. The phase 3 PORT-C randomized clinical trial.
        JAMA Oncol. 2021; 7: 1178-1185
        • Brandt W.S.
        • et al.
        Postoperative radiotherapy for surgically resected ypN2 non-small cell lung cancer.
        Ann Thorac Surg. 2018; 106: 848-855

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