Annals of Surgical Oncology

, Volume 25, Issue 5, pp 1245–1253 | Cite as

Concurrent Versus Sequential Chemoradiation Therapy in Completely Resected Pathologic N2 Non-Small Cell Lung Cancer: Propensity-Matched Analysis of the National Cancer Data Base

  • Amy C. Moreno
  • Waqar Haque
  • Vivek Verma
  • Penny Fang
  • Steven H. Lin
Thoracic Oncology



Following complete resection of pN2 non-small cell lung cancer (NSCLC), national guidelines recommend either sequential (sCRT) or concurrent chemoradiotherapy (cCRT). This is the largest study to date evaluating survival between both approaches. In sCRT patients, sequencing ‘chemotherapy first’ versus ‘radiotherapy first’ was also addressed.


The National Cancer Data Base (NCDB) was queried for patients with primary NSCLC undergoing surgery (without neoadjuvant radiotherapy or chemotherapy), pN2 disease with negative surgical margins, and receiving postoperative CRT. Multivariable logistic regression ascertained factors associated with cCRT administration. Kaplan–Meier analysis evaluated overall survival (OS), and Cox proportional hazards modeling determined variables associated with OS. Propensity matching was performed to address group imbalances and indication biases.


Of 1924 total patients, 1115 (58%) received sCRT and 809 (42%) underwent cCRT. Median OS in the sCRT and cCRT cohorts was 53 months versus 37 months (p < 0.001); differences persisted following propensity matching (p = 0.002). In the sCRT population, there was a trend for higher OS in the ‘chemotherapy first’ group, relative to ‘radiotherapy first’ (55 vs. 44 months, p = 0.079), but there were no statistically apparent differences following propensity matching (p = 0.302).


For completely resected pN2 NSCLC, delivering adjuvant sCRT was associated with improved survival over cCRT. Toxicity-related factors may help to explain these results but need to be better addressed in further investigations. Differential sequencing of sCRT did not appear to affect survival.




Steven H. Lin has received research funding from Elekta, STCube Pharmaceuticals, Peregrine, Bayer, and Roche/Genentech, and has served as a consultant for AstraZeneca and received honorarium from US Oncology and ProCure. Amy C. Moreno, Waqar Haque, Vivek Verma, and Penny Fang declare no conflicts of interest.


No research support was received for this study.


None. This work has not been previously presented or published in any form.

Supplementary material

10434_2018_6399_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 20 kb)
10434_2018_6399_MOESM2_ESM.tiff (51 kb)
Supplemental Figure 1. Effect of clinical nodal status (cN0-1 versus cN2) on overall survival in both the sCRT (A) and cCRT (B) patients. Supplementary material 2 (TIFF 52 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Amy C. Moreno
    • 1
  • Waqar Haque
    • 2
  • Vivek Verma
    • 3
  • Penny Fang
    • 1
  • Steven H. Lin
    • 1
  1. 1.Department of Radiation OncologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Radiation OncologyHouston Methodist HospitalHoustonUSA
  3. 3.Department of Radiation OncologyUniversity of Nebraska Medical CenterOmahaUSA

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