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Proffered Paper session - Non-metastatic NSCLC and other thoracic malignancies

1170O - An international randomized trial, comparing post-operative conformal radiotherapy (PORT) to no PORT, in patients with completely resected non-small cell lung cancer (NSCLC) and mediastinal N2 involvement: Characterisation of PORT efficacy in lung ART (IFCT-0503, UK NCRI, SAKK)


17 Sep 2021


Proffered Paper session - Non-metastatic NSCLC and other thoracic malignancies


Clinical Research;  Surgical Oncology;  Radiation Oncology

Tumour Site

Non-Small Cell Lung Cancer


Cécile Le Pechoux


Annals of Oncology (2021) 32 (suppl_5): S939-S948. 10.1016/annonc/annonc728


C. Le Pechoux1, F. Barlesi2, N. Pourel3, C. Faivre-Finn4, D. Lerouge5, G. Zalcman6, D. Antoni7, B. Lamezec8, U. Nestle9, P. Boisselier10, F. Thillays11, A. Paumier12, E. Dansin13, K. Peignaux14, J. Madelaine15, E. Pichon16, A. Larrouy17, O. Riesterer18, A. Lavolle19, A. Bardet20

Author affiliations

  • 1 Radiation Oncology, Gustave Roussy Cancer Campus, 94805 - Villejuif/FR
  • 2 Medical Oncology Department, Aix Marseille University, CNRS, INSERM, CRCM, APHM Affiliation and Gustave Roussy Cancer Campus, 94805 - Marseille, Villejuif/FR
  • 3 Radiation Oncology, Institut Ste Catherine, Avignon/FR
  • 4 Clinical Oncology Department, University of Manchester and The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 5 Radiation Oncology, Centre Baclesse, Caen/FR
  • 6 Thoracic Oncology, CIC1425-CLIP2 Paris-Nord, Bichat-Claude Bernard Hospital, APHP, Paris/FR
  • 7 Radiation Oncology, Centre Paul Strauss, Strasbourg/FR
  • 8 Radiation Oncology, Centre Armoricain de Radiothérapie, d’Imagerie Médicale et d’Oncologie, 22000 - St. Brieuc/FR
  • 9 Radiation Oncology, University Hospital Freiburg and Kliniken Maria Hilf, 79106 - Freiburg/DE
  • 10 Radiation Oncology, Centre Val d’Aurelle, 34090 - Montpellier/FR
  • 11 Radiation Oncology, Centre René Gauducheau ICO, 44805 - Nantes/FR
  • 12 Radiation Oncology, Centre Paul Papin ICO, 49055 - Angers/FR
  • 13 Medical Oncology, Centre Oscar Lambret, 59020 - Lille/FR
  • 14 Radiation Oncology, Centre Georges François Leclerc, 77980 - Dijon/FR
  • 15 Pneumology, Centre Hospitalier Universitaire de Caen, 14033 - Caen/FR
  • 16 Pneumology, Centre Hospitalier Universitaire de Tours, 37044 - Tours/FR
  • 17 Radiation Oncology, Centre Specialisé Cancerologie Paris Nord, 95200 - Sarcelles/FR
  • 18 Radiation Oncology, University Hospital Zurich, University of Zurich, Swiss Group for Clinical Cancer Research, 8091 - Zurich/CH
  • 19 Thoracic Oncology, Tenon University Hospital, APHP, Paris/FR
  • 20 Biostatistics And Epidemiology, Oncostat U1018, Inserm, University Paris-saclay, Labeled Ligue Contre Le Cancer, Gustave Roussy Cancer Campus, 94805 - Villejuif/FR


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Abstract 1170O


Primary analysis of Lung ART trial has shown (ESMO 2020) a non-statistically significant effect of PORT on disease-free survival (DFS) in N2 NSCLC patients (HR = 0·86 (95% CI 0·68-1·08]; p=0·18). However PORT was associated with a reduction of 51% in the risk of mediastinal relapse (MR). Patterns of relapse as well as prognostic factors of PORT efficacy warranted further investigations to determine which patients could benefit more from PORT.


Patients were eligible in Lung ART if they had a WHO performance status ≤2, considered to have undergone complete resection with lymph node exploration, proven N2 disease +/- prior neo-adjuvant or adjuvant CT. DFS components (metastatic, mediastinal relapses and deaths) were analysed using competing risks approaches. Prognosis factors for DFS and OS were explored based on prespecified analyses coupled with an exploratory approach.


501 patients were randomised. Among DFS events, there are 161 (54%) metastatic relapses (including 61 (21%) brain metastases), 106 (36%) MR, and 29 (10%) deaths. Three-year metastatic relapse-free survival is 72.31% [66.5;77.1] and 68.47% [61.7;74] in the control and PORT arms, respectively; 3-year MR-free survival is 72.26% [65.9;77.4] and 86.06% [81.2;89.7], respectively. MR occurs mainly within initially involved nodes (66% in control arm, 47% in PORT arm) and significantly less in PORT arm (unadjusted sub-distribution HR= 0.46 (95% CI [0.3;0.7]). The 3 most frequent sites of MR are stations 7 (47%), 4L (42%), 4R (37%) for left-sided tumours; stations 4R (48%), 2R (44%) and 7 (41%) for right-sided tumours. Prognostic factors for DFS include quality of resection, extent of mediastinal involvement and lymph node ratio (involved / explored), with differential effects according to DFS components. With regards to overall survival, extent of nodal involvement is a significant prognostic factor whereas PORT (HR = 0.98 [0.7;1.4]) is not.


Use of PORT in N2 NSCLC patients reduces the risk of MR, but has no significant impact on DFS. Prognostic factors associated with different DFS components were identified which may allow a personalized prescription of PORT.

Clinical trial identification


Legal entity responsible for the study

Gustave Roussy.


French National Cancer Institute (INCa), French Health Ministry (PHRC), Gustave Roussy and Cancer Research UK grant (A13969).


C. Le Pechoux: Non-Financial Interests, Institutional, Advisory Board, Outside the submitted work: AstraZeneca, Nanobiotix, Roche; Non-Financial Interests, Institutional, Invited Speaker, Outside the submitted work: Amgen, Eli Lilly, Medscape; Financial Interests, Personal, Invited Speaker, Outside the submitted work: PriME Oncology. F. Barlesi: Financial Interests, Personal, Other: AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Eli Lilly Oncology, F. Hoffmann-La Roche Ltd., Novartis, Merck, Mirati, MSD, Pierre Fabre, Pfizer, Sanofi-Aventis, Seattle Genetics, Takeda; Financial Interests, Institutional, Other, Outside the submitted work: AbbVie, ACEA, Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Eisai, Eli Lilly Oncology, F. Hoffmann-La Roche Ltd., Genentech, Ipsen, Ignyta, Innate Pharma, Loxo, Novartis, MedImmune, Merck, MSD, Pierre Fabre, Pfizer, Sanofi-Aventis. N. Pourel: Non-Financial Interests, Institutional, Research Grant, Outside the submitted work: Pfizer, Varian. C. Faivre-Finn: Financial Interests, Institutional, Research Grant, Outside the submitted work: AstraZeneca, Elekta. G. Zalcman: Financial Interests, Personal, Advisory Board, All outside the submitted work: BMS, MSD, AstraZeneca, Boehringer Ingelheim; Non-Financial Interests, Institutional, Research Grant, All outside the submitted work: Roche, Takeda AstraZeneca, AbbVie. A. Bardet: Financial Interests, Personal, Other, Consultancy fees: Roche. All other authors have declared no conflicts of interest.

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