The following is the summary of “Value of Radiotherapy in Patients With Resectable Stage IIIA Non–Small-Cell Lung Cancer in the Era of Individualized Treatment: A Population-Based Analysis” published in the January 2023 issue of Clinical Lung Cancer by Liu, et al.

When it comes to the value of radiotherapy for patients with resected stage IIIA NSCLC, there is currently no agreement. In 2017, there was a major reorganization of stage IIIA. The purpose of this research is to determine whether or not radiation improves survival for patients with resectable stage IIIA NSCLC. The Surveillance, Epidemiology, and End Results database was queried to identify patients with non-small cell lung cancer (NSCLC) diagnosed between 2010 and 2018 according to the 8th version of the tumor nodes and metastases (TNM) classification. 

Taking into account all potential factors that could affect a patient’s outcome, researchers were able to create a nomogram for lung cancer-specific survival (LCSS). Subgroup analysis and Propensity Score Matching (PSM) were used to reduce the possibility of bias. Kaplan-Meier and Cox proportional hazards regression were used to analyze survival. To date, 2,632 patients with stage IIIA NSCLC have been enrolled. Nomogram predicting LCSS had a C-index of 0.636 (95% CI, 0.616-0.656). For patients with N2 stage and more than 5 positive regional lymph nodes, PORT did increase postoperative survival time (50 vs. 31 months; P=.005) compared to not performing PORT. 

Adjuvant radiation may also assist patients with N2 who have visceral pleural invasion (VPI), are beyond the age of 65, or have tumors that are greater than 3 cm in diameter. It is important to tailor treatment plans for patients with stage IIIA NSCLC. Their data suggest that patients with N2 disease who also have VPI, a tumor size of more than 3 cm, are older than 65, and/or have more than 5 positive regional lymph nodes may benefit from adjuvant radiation. Additional high-quality randomized trials are needed.