Thread by @StephenVLiu

#ESMO20 Practice changing data presented by Dr. Cecile Le Pechoux @GustaveRoussy. The prospective, randomized phase III LUNG-ART study explores the benefit of post-operative radiotherapy for completely resected #NSCLC: no OS benefit seen. #LCSM @OncoAlert

#ESMO20 Post-operative radiotherapy found to be detrimental after resection for pN0 and pN1 NSCLC but unclear role in pN2. Data supporting its benefit but lack of prospective studies. Had been standard for many in pN2 (including myself). #LCSM @OncoAlert

#ESMO20 The LUNG ART phase III trial (IFCT-0503) enrolled patients with completely resected N2 NSCLC and randomized 1:1 to 3D conformal post operative radiotherapy (54 Gy over 5.5 weeks). Median follow up nearly 5 years. #LCSM @OncoAlert

#ESMO20 This was a fairly rigorous trial. 96% of patients received adjuvant chemotherapy, over 90% were staged with PET. All had N2 involvement and 40% were microscopic, unforeseen N2 (reminder of how important mediastinal staging is). #LCSM @OncoAlert

#ESMO20 Mostly lobectomy (10-12% pneumonectomy), 89% 3DRT, median lung V20 was 23%. #LCSM @OncoAlert

#ESMO20 Primary endpoint here. No significant difference in PFS. 3y PFS rate 43.8% in control and 47.1% with PORT, median 22.8m vs 30.5m (HR 0.85, p=0.16). #LCSM @OncoAlert

#ESMO20 When we look at DFS, control arm much more likely to suffer mediastinal relapse (46.1% vs 25%) but death more common in the PORT arm (14.6% vs 5.3%). #LCSM @OncoAlert

#ESMO20 LUNG ART showed PORT did not impact survival. The 3y OS rate was 66.5% with PORT and 68.5% without PORT. Causes of death differed: in the control arm, 86.1% of deaths due to recurrence vs 69.4% with PORT but cardio-pulmonary deaths in 16.2% of PORT vs. 2% in control #LCSM

#ESMO20 LUNG ART showed no improvement in DFS or OS with post-operative radiotherapy for completely resected N2 NSCLC. In fact, PORT had a non-significant increase in DFS and increased cardiopulmonary toxicity. Routine PORT no longer SOC. #LCSM @OncoAlert