Validation of the Standardized Needs Evaluation Questionnaire in Polish Cancer Patients.

BACKGROUND: Cancer influences various aspects of patients' functioning. Cancer patients face not only medical problems but also organizational, socio-psychological, and spiritual problems. Their needs often seem to be unrecognized because patients do not express their concerns and clinicians do not ask appropriate questions. Unmet needs impact patients' quality of life. The aim of this study was to select, adapt, validate, and introduce a simple instrument for estimating cancer patients' unmet needs in Poland. METHODS: The Needs Evaluation Questionnaire (NEQ) was chosen for validation in a Polish population. The Polish version of the NEQ was developed with a back-translation procedure, as approved by a psycho-oncologist and a public health specialist. The psychometric properties of the NEQ (content analysis, reliability, construct validity, comprehensibility, and acceptability) were measured. RESULTS: This study was performed on a group of 121 cancer patients. The median time of completion for the NEQ was 10 min. The form, length, and font size of the NEQ were accepted by the respondents. Overall, the meaning of the questions was well understood, with only a few cases of discreetly heterogeneous interpretation of the content. The questionnaire showed good reliability and internal factor structure validity. CONCLUSION: The NEQ is a simple, easy-to-administer instrument with good psychometric properties and seems to be useful in assessing the unexpressed needs of cancer patients.

Errate: Dysregulation of Inflammation, Oxidative Stress, and Glucose Metabolism-Related Genes and miRNAs in Visceral Adipose Tissue of Women with Type 2 Diabetes Mellitus.

The authors informed the journal that errors occurred in their manuscript, and were not noticed by the authors during the proofreading. Corrections: 1. Figure 1, top entry: "Predipocytes" should read "Preadipocytes". 2. Figure 3, chart "TIGAR": "-9" value on y axis should read "-8". 3. Figure 4, chart "let-7g-5p": the upper "-4" value on y axis should read "0". 4. Figure 5: the title of the bottom right chart should read "TIGAR". 5. Figure 6, chart "miR-26a-5p": the values on y axis should read from the top: 2, 1, 0, -1, -2. 6. Figure 6, chart "miR-374a-5p": the values on y axis should read from the top: 0, -1, -2, -3, -4. 7. Table 4., in the 6 rows from the bottom: in column "miRNAs", "hsa-miR-21-5" should read "hsa-miR-21-5p". 8. Supplementary Table1, 1st column on the left: "TG-HDL" should read "TG/HDL" Reference: Adam Wróblewski, Justyna Strycharz, Katarzyna Oszajca, Piotr Czarny, Ewa Swiderska, Tomasz Matyjas, Andrzej Zieleniak, Monika Rucinska, Lech Pomorski, Józef Drzewoski, Agnieszka Sliwinska, Janusz Szemraj: Dysregulation of Inflammation, Oxidative Stress, and Glucose Metabolism-Related Genes and miRNAs in Visceral Adipose Tissue of Women with Type 2 Diabetes Mellitus. Med Sci Monit, 2023; 29: e939299. DOI: 10.12659/MSM.939299.

Unmet non-medical needs of cancer patients in Poland: a quantitative and qualitative study.

PURPOSE: Cancer itself and its treatment have a multifaceted impact on patients' daily lives. The aim of the study was to determine unmet non-medical needs among Polish cancer patients. METHODS: Survey research using a 23-item Needs Evaluation Questionnaire (NEQ) was carried out among 1062 cancer patients from different regions of Poland. Quantitative and qualitative analyses were performed. RESULTS: The quantitative analysis showed that 48% of the NEQ items (11/23) were expressed as unmet needs by at least half of patients. Unmet information needs were indicated by patients most often: information about their diagnosis, exams, treatment, future condition, funding and economic support. Cancer patients would like to get more attention from medical staff. Unmet needs were most frequently expressed by respondents who were men, with a lower level of education, living in village, pensioners. Qualitative analysis showed that each need may be understood in a variety of different ways across the cohort. Some patients added comments that the completing NEQ helped them to notice their non-medical needs. CONCLUSION: Polish cancer patients have some unmet non-medical needs, especially informative needs.

Dysregulation of Inflammation, Oxidative Stress, and Glucose Metabolism-Related Genes and miRNAs in Visceral Adipose Tissue of Women with Type 2 Diabetes Mellitus.

BACKGROUND Human visceral adipose tissue (VAT), now identified as an endocrine organ, plays a significant role in impaired fasting glucose and diabetes through the deregulated metabolism and adipogenesis of visceral adipocytes in obesity. Our study focuses on exploring the link between inflammation, oxidative stress, and glucose metabolism-associated genes with corresponding miRNAs in human visceral adipocytes and VAT from individuals with glucose metabolism disorders. MATERIAL AND METHODS We examined the expression of ATM, NFKB1, SOD2, INSR, and TIGAR, along with their related miRNAs using PCR, in two contexts:1 - During the three-stage visceral adipogenesis under normal glucose levels (5.5 millimoles), intermittent, and chronic hyperglycemia (30 millimoles).2 - In visceral adipose tissue from subjects (34 F, 18 M) with normal glucose metabolism, impaired fasting glucose, and type 2 diabetes mellitus. RESULTS Both chronic and intermittent hyperglycemia similarly influenced ATM, NFKB1, TIGAR, SOD2, INSR gene expression in visceral adipocytes, with corresponding changes in a few tested miRNAs (eg, let-7g-5p, miR-145-5p, miR-21-5p). Anthropometric and biochemical parameters led us to focus on female subjects. Our results showed transactivation of NFKB1, TIGAR, miR-10b-5p, miR-132-3p, miR-20a-5p, miR-21-5p, and miR-26a-5p exclusively in type 2 diabetes mellitus. Upregulated molecules (excluding miR-10b-5p and miR-20a-5p) positively correlated with glucose metabolism markers. CONCLUSIONS The genes studied may undergo miRNA interferences and hyperglycemic memory in visceral adipocytes under hyperglycemic conditions. VAT from women with type 2 diabetes mellitus, but not with impaired fasting glucose, showed transactivated miRNAs and a molecular dysregulation of TIGAR and NFKB1, possibly enhancing inflammation, oxidative stress, and disrupted glucose metabolism. These findings highlight the epigenetic and molecular disturbances in VAT related to glucose metabolism abnormalities. However, additional research is necessary to further understand their biological significance.

Is It Possible to Notice the Unmet Non-Medical Needs among Cancer Patients? Application of the Needs Evaluation Questionnaire in Men with Lung Cancer.

BACKGROUND: Lung cancer is the most common cause of cancer death worldwide. It is the most frequently diagnosed cancer in men. Lung cancer causes not only physical symptoms related to the disease itself and its treatment but also numerous mental, social and spiritual problems. The aim of the study was to assess non-medical needs among male lung cancer patients during oncological treatment. MATERIALS AND METHODS: The study was conducted on a group of 160 men (mean age 67 years) treated for lung cancer from June 2022 until November 2022 in 5 oncological centers in Poland. The Needs Evaluation Questionnaire (NEQ) was used. The NEQ explores five areas of patients' needs: informative, connected with assistance/care, relational, material and psycho-emotional support. RESULTS: All participants (except one) expressed some unmet non-medical needs (mean and median 11). Male lung cancer patients indicated informative needs most frequently. There were no significant differences between expressed unmet needs based on age, place of residence, professional activity or marital status. CONCLUSIONS: The NEQ seems to be a proper instrument to explore the non-medical needs of cancer patients. Adequate measures to address the unmet needs of lung cancer patients could contribute to an improved quality of life.

The Impact of the COVID-19 Pandemic on the Number of Cancer Patients and Radiotherapy Procedures in the Warmia and Masuria Voivodeship.

(1) Background: It was suspected that the COVID-19 pandemic would negatively affect health care, including cancer treatment. The aim of the study was to assess the impact of the COVID-19 pandemic on the number of radiotherapy procedures and patients treated with radical and palliative radiotherapy in Poland. (2) Methods: The study was carried out in Warmia and Masuria voivodeship. The number of procedures and treated patients one year before and in the first year of the COVID-19 pandemic were compared. (3) Results: In the first year of the COVID-19 pandemic, the number of radiotherapy procedures and cancer patients treated with radiotherapy in Warmia and Masuria voivodeship in Poland was stable compared to the period before the pandemic. The COVID-19 pandemic has not affected the ratio of palliative to radical procedures. The percentage of ambulatory and hostel procedures significantly increased with the reduction of inpatient care in the first year of the COVID-19 pandemic. (4) Conclusion: No significant decrease in patients treated with radiotherapy during the first year of the pandemic in Warmia and Masuria voivodeship in Poland could indicate the rapid adaptation of radiotherapy centers to the pandemic situation. Future studies should be carried out to monitor the situation because the adverse effects of the pandemic may be delayed.

Pathway-level mutation analysis in primary high-grade serous ovarian cancer and matched brain metastases.

Brain metastases (BMs) in ovarian cancer (OC) are a rare event. BMs occur most frequently in high-grade serous (HGS) OC. The molecular features of BMs in HGSOC are poorly understood. We performed a whole-exome sequencing analysis of ten matched pairs of formalin-fixed paraffin-embedded samples from primary HGSOC and corresponding BMs. Enrichment significance (p value; false discovery rate) was computed using the Reactome, the Kyoto Encyclopedia of Genes and Genomes pathway collections, and the Gene Ontology Biological Processes. Germline DNA damage repair variants were found in seven cases (70%) and involved the BRCA1, BRCA2, ATM, RAD50, ERCC4, RPA1, MLHI, and ATR genes. Somatic mutations of TP53 were found in nine cases (90%) and were the only stable mutations between the primary tumor and BMs. Disturbed pathways in BMs versus primary HGSOC constituted a complex network and included the cell cycle, the degradation of the extracellular matrix, cell junction organization, nucleotide metabolism, lipid metabolism, the immune system, G-protein-coupled receptors, intracellular vesicular transport, and reaction to chemical stimuli (Golgi vesicle transport and olfactory signaling). Pathway analysis approaches allow for a more intuitive interpretation of the data as compared to considering single-gene aberrations and provide an opportunity to identify clinically informative alterations in HGSOC BM.

Identification of Cognitive Strategies Used by Cancer Patients as a Basis for Psychological Self-Support during Oncological Therapy.

Background: Cancer diagnosis is associated not only with health problems but also with psycho-social disability. Both medical and non-medical problems have impacts on cancer patients' quality of life. The aim of the study was the identification of cognitive emotion regulation strategies among cancer patients during radiotherapy. Methods: The study was conducted on 78 radically treated cancer patients (median 63 years). A Cognitive Emotion Regulation Questionnaire (CERQ) was used. Results: Cancer patients mostly used acceptance, positive refocusing, putting into perspective and refocus on planning. Age was inversely correlated with refocus on planning. Patients with higher levels of education tended to use rumination and catastrophizing less frequently (p < 0.05). Adaptive cognitive strategies based on putting into perspective were more frequently used by professionally active patients (p < 0.05). Patients who lived in cities used positive refocusing and putting into perspective significantly often and patients who lived in villages more frequently used catastrophizing (p < 0.05). Among lung cancer patients, catastrophizing and rumination were popular (p < 0.05) and breast cancer patients rarely used non-adaptive cognitive strategies. Conclusion: Cancer patients tended to use adaptive cognitive strategies. Personalized psychological support should be focused on lung cancer patients and older, less educated, unemployed individuals and people who lived in the countryside.

Complementary and Alternative Medicine Use in Hospitalized Cancer Patients-Study from Silesia, Poland.

BACKGROUND: The use of complementary and alternative medicine (CAM) is common amongst cancer patients. The aim of the study was to investigate the use of CAM, beliefs about CAM and the purpose of using it amongst Polish cancer patients. METHODS: The study included 864 cancer patients (median 63 years old), who were individually interviewed. The questionnaire was designed specifically for this study. RESULTS: Amongst 732 patients who declared that they heard about CAM, 342 patients (46.7%) had used CAM; 91% of these patients had used it as a complementary therapy and 9% had used it as an alternative therapy. Patients younger in age, highly educated, professionally active, with longer medical history, and at more advanced cancer stages have, statistically, used CAM more often; 66% of participants could not state what the health effect of CAM is. Patients received information about CAM from the internet, friends, family and other patients. Only 18% of patients discussed using CAM with a doctor. CONCLUSIONS: CAM was popular amongst Polish cancer patients, especially in younger, educated and professionally active patients with longer cancer history at advanced stage. Patients used CAM as a complementary therapy for strengthening immune system, improving morphological and biochemical test parameters, reducing the side effects of conventional therapy and improving their well-being.

Students' Knowledge about Cervical Cancer Prevention in Poland.

Background and Objectives: In Poland, the rates of morbidity and mortality due to cervical cancer are amongst the highest in Europe. A significant percentage of newly diagnosed cases of cervical cancer are at an advanced stage. Unfortunately, only about 20% of Polish women take part in cervical cancer screening. The aim of the study was to assess students' knowledge of cervical cancer risk factors and prevention. Materials and Methods: The study was provided to Polish students from various universities and faculties between May 2020 and November 2020. The questionnaire was designed specifically for this study and was validated. The chi-square test was used to compare the responses between subgroups. Results: The study was carried out on a group of 995 students (80.6% women, 19% men, 0.4% no data), (average age 21.9 years). Most students knew that the main risk factor for cervical cancer is human papillomavirus (HPV) infection (82% of all responders; 86% of medical students; 73% of non-medical students; p < 0.001). Only 40% of students knew that in Poland the Population Prevention and Early Diagnosis Program is carried out on women aged 25-59 years every three years. Most students correctly indicated that cervical cancer screening in Poland is performed using cervical cytology and were familiar with the basis of cytology. Only 57% of students knew that there are no specific early symptoms of cervical cancer. A total of 78% of all respondents knew that HPV vaccination reduces the risk of cervical cancer. Medical students and students who are sexually active demonstrated a better knowledge of cervical cancer. Conclusions: The Polish students had some knowledge of cervical cancer risk factors and primary and secondary prevention. Significantly better knowledge was demonstrated by medical students. Some efforts should be made to ensure that young people, who are not associated with medicine are better educated about cervical cancer in order to reduce the overall incidence and improve early detection rates.

WBRT for brain metastases from non-small cell lung cancer: for whom and when?-Contemporary point of view.

The incidence of brain metastases (BM) is estimated between 20% and 40% of patients with solid cancer. The most common cause of this failure is lung cancer, and in locally advanced non-small cell lung cancer (NSCLC) BM represent a common site of relapse in 30-55% cases. The basic criteria of therapeutic decision-making are based on the significant prognostic factors which are components of prognostic scores. The standard approach to treatment of BM from NSCLC include whole brain radiotherapy (WBRT) which is used as adjuvant modality after local therapy (surgery or stereotactic radiosurgery) or as primary treatment and it remains the primary modality of treatment for patients with multiple metastases. WBRT is also used in combination with systemic therapy. The aim of presented review of literature is trying to answer which patients with BM from NSCLC should receive WBRT and when it could be omitted. There were presented the aspects of application of WBRT in relation to (I) choice between WBRT or the best supportive care and (II) employment of WBRT in combination with local treatment modalities [surgical resection or stereotactic radio-surgery (SRS)] and/or with systemic therapy. According to data from literature we concluded that the most important factor that needs to be considered when assessing the suitability of a patient for WBRT is the patient's prognosis based on the Lung-molGPA score. WBRT should be applied in treatment of multiple BM from lung cancer in patients with favourable prognosis and in in patients with presence of EML4-ALK translocation before therapy with crizotinib. Whereas WBRT could be omitted in patients with poor prognosis and after primary SRS.

Polish High School Students' Knowledge about Cancer.

BACKGROUND: Cancer, as the second most common cause of death after cardiovascular diseases, is a global health problem. There is still an increasing number of cancer incidences and deaths. METHODS: The study was conducted as a part of the health promotion educational project concerning oncological education to develop the knowledge of cancer risk factors among high school students in Poland. A special questionnaire was filled out by students before the educational lesson on cancer conducted by medical students and young doctors. RESULTS: The study was carried out on 227 high school students (aged 17-18 years). Most students (67.5%) indicated that genetic predisposition is the most important cancer risk factor. Only about a quarter of students pointed to the relationship between lifestyle and cancer. Moreover, 41% of students admitted to smoking cigarettes. Most of them (80.6%) claimed that they can modify their own cancer risk. Almost all responders believed that early detected cancer is curable. CONCLUSIONS: High school students do not know about cancer risk factors and they do not relate cancer with lifestyle. Some students indicated bad lifestyle habits such as tobacco smoking. It is necessary to emphasize cancer prevention in early education, especially focusing on modification of lifestyle.

Visceral Adipose Tissue of Prediabetic and Diabetic Females Shares a Set of Similarly Upregulated microRNAs Functionally Annotated to Inflammation, Oxidative Stress and Insulin Signaling.

Hypertrophic and hypoxic visceral adipose tissue (VAT) secretes proinflammatory cytokines promoting insulin resistance (IR), prediabetes and type 2 diabetes (T2DM) microRNAs (miRNAs) are markers of metabolic disorders regulating genes critical for e.g., inflammation, glucose metabolism, and antioxidant defense, with raising diagnostic value. The aim of the current study was to evaluate whether hyperglycemia is able to affect the expression of selected miRNAs in VAT of prediabetic (IFG) and diabetic (T2DM) patients vs. normoglycemic (NG) subjects using qPCR. Statistical analyses suggested that miRNAs expression could be sex-dependent. Thus, we determined 15 miRNAs as differentially expressed (DE) among NG, T2DM, IFG females (miR-10a-5p, let-7d-5p, miR-532-5p, miR-127-3p, miR-125b-5p, let-7a-5p, let-7e-5p, miR-199a-3p, miR-365a-3p, miR-99a-5p, miR-100-5p, miR-342-3p, miR-146b-5p, miR-204-5p, miR-409-3p). Majority of significantly changed miRNAs was similarly upregulated in VAT of female T2DM and IFG patients in comparison to NG subjects, positively correlated with FPG and HbA1c, yet, uncorrelated with WHR/BMI. Enrichment analyses indicated involvement of 11 top DE miRNAs in oxidative stress, inflammation and insulin signaling. Those miRNAs expression changes could be possibly associated with low-grade chronic inflammation and oxidative stress in VAT of hyperglycemic subjects.

Patients' Non-Medical and Organizational Needs during Cancer Diagnosis and Treatment.

The aim of this cross-sectional study was to determine non-medical and organizational needs among cancer patients during diagnosis and treatment. The study included 384 cancer patients treated in five oncological centers in Poland. A questionnaire designed for the study was used. Most of the patients received psychological support from their partner/family/friends (88%), to a lesser extent from a psychologist (21%) and priests (4%). Forty-three percent of patients received social support from their partner/family/friends and only 7% of respondents received support from a social worker. Most patients stated they would like to have a professional who would help them with their non-medical problems during the diagnostic process and cancer treatment. The youth, with a higher education level who were professionally active and living in cities seemed to be more aware of their needs. Improvements to the oncological system in Poland should focus on expanding patient access to professional support of non-medical needs.

Postoperative radio-chemotherapy for rectal cancer: A retrospective analysis from a tertiary referral hospital.

AIM: To report results of postoperative radio-chemotherapy (RT-CHT) for rectal cancer (RC). BACKGROUND: Total mesorectal excision (TME) is an essential treatment method in rectal cancer (RC). Perioperative radiotherapy in locally advanced RC improves loco-regional free survival (LRFS). Preoperative radiotherapy is a preferred option; however, some patients are not referred for it. In case of the risk of loco-regional failure postoperative radio-chemotherapy (RT-CHT) is indicated. MATERIAL AND METHODS: Between 2004 and 2010, 182 patients with pathological stage II-III RC (TME performed - 41%, resection R0 - 88%, circumferential resection margin evaluated - 55.5% and was above 2 mm in 66% of them) received postoperative RT-CHT in our institution. Overall survival (OS) and LRFS were estimated with the Kaplan-Meier method. Univariate and multivariate analysis were performed to compare the impact of prognostic factors on survival. RESULTS: Five-year OS and LRFS rates were 63% and 85%, respectively. Loco-regional recurrence and isolated distant metastases rates were 11.5% and 19%, respectively. Multivariate analysis showed stage (III vs. II), HR: 2.3 (95% confidence interval [CI]: 1.4-3.8), p = 0.0001; extent of resection (R1-2 vs. R0), HR: 2.14 (95%CI: 1.14-3.99), p = 0.017, and age (>65 vs. ≤65 years), HR: 1.66 (95%CI: 1.06-2.61), p = 0.027 as prognostic factors for OS. Extent of resection (R1-2 vs. R0), HR: 3.65 (95%CI: 1.41-9.43), p = 0.008 had significant impact on LRFS. CONCLUSION: Despite a suboptimal quality of surgery and pathological reports, the outcome in our series is close to that reported in the literature. We confirm a strong impact of the extent of resection on patient's outcome, which confirms the pivotal role of surgery in the management of RC.

SHARP hypofractionated stereotactic radiotherapy for localized prostate cancer: a biochemical response to treatment.

PURPOSE: The standard treatment for patients with early-stage prostate cancer are operation and radiotherapy. Stereotactic body radiation therapy (SBRT) is one of the new radiotherapy methods. The aim of the study was to analyze tumor control of prostate cancer patients treated with SBRT. METHODS: A prospective single-institution clinical study was conducted among previously untreated patients with histologically confirmed localized prostate cancer. Patients were treated with SBRT: 33.5 Gy in 5 fractions. RESULTS: A total of 68 men with clinical stage of prostate cancer T1c-T2cN0M0 were included in the study. The median combined Gleason score was 6, the median PSA level was 10ng/mL. The median follow-up period was 48 months. Five years after the end of radiotherapy, the median PSA levels were as follows: 0.29ng/mL for all patients, 0.39ng/mL for those who did not receive androgen deprivation therapy, 0.25ng/mL for patients who underwent 6 months and 0.31ng/mL for patients who underwent 2-3 years of hormone therapy. Median nadir PSA levels were 0.025ng/mL for all patients and 0.48ng/mL for patients without hormone therapy. Low PSA nadir (<0.5ng/ml) was noted in 50% of patients without hormone therapy and in 70% of all other patients. Only in 4 patients (out of those who did not receive hormone therapy) PSA failure was observed (nadir plus 2ng/mL). No cases of PSA failure were noted among patients who underwent 6 months or 2-3 years of androgen deprivation therapy. CONCLUSION: A good biochemical control was observed in prostate cancer patients treated with SBRT at 5 years follow-up.

The Waiting Time of Prostate Cancer Patients in Poland.

Background: Prostate cancer is the second most common reason of mortality due to cancer among men in Poland. The study aimed to determine the waiting time for diagnosis and treatment of prostate cancer. Methods: The study was carried out on patients treated for prostate cancer from May 2014 to February 2015 at five oncological centres in Poland. The median waiting time was measured from the time cancer was suspected to the histopathological diagnosis (SDI), from the cancer suspicion to the start of treatment (STI) and from the diagnosis to the start of treatment (DTI). Results: 123 males treated for prostate cancer were included for analysis. The median time for SDI, STI and DTI was 7.7, 18.7 and 8.7 weeks, respectively. Place of residence was the only factor which influenced STI (p = 0.003). For patients, who started treatment with radiation therapy DTI was longer than for other patients (p < 0.001). Conclusions: Median times of STI, SDI and DTI for prostate cancer patients in Poland are similar to the intervals described in other countries. Patients, who lived further from an oncology centre waited longer for treatment. The impact of waiting time in the case of prostate cancer on improving the prognosis is still unclear.

How Long Are Cancer Patients Waiting for Oncological Therapy in Poland?

BACKGROUND: The five-year relative survival rate in Poland is approximately 10% lower compared with the average for Europe. One of the factors that may contribute to the inferior treatment results in Poland could be the long time between cancer suspicion and the beginning of treatment. The aim of the study was to determine the real waiting time for cancer diagnosis and treatment in Poland. METHODS: The study was carried out in six cancer centers on a group of 1373 patients, using a questionnaire to interview patients. The median waiting time was estimated as follows: (A) from suspicion (the date of the first visit, with symptoms, to a doctor or a preventive or screening test) until histopathological diagnosis; (B) from suspicion until initial treatment; and (C) from diagnosis until initial treatment. RESULTS: The median times from suspicion to treatment, from suspicion to diagnosis, and from diagnosis to treatment, were 10.6, 5.6, and 5.0 weeks, respectively. Using multivariate analysis, the strongest influence was estimated, in a case of tumor localization, to be the method of initial treatment and facilities. CONCLUSION: The waiting time for cancer treatment in Poland is too long. The highest influence on waiting time was determined, in the case of tumors, as the type of cancer and factors related to the health care system.

Sequencing postoperative radiotherapy and adjuvant chemotherapy in non-small cell lung cancer: unanswered questions on the not evidence-based approach.

This editorial comments on the study by Lee et al. which reported on the use of postoperative radiotherapy (PORT) as first strategy after resection of stage IIIA-pN2 non-small cell lung cancer (NSCLC). After completion of PORT, 41% of patients received postoperative chemotherapy (POCT). The five-year overall survival (OS) was significantly higher in patients treated with PORT and POCT than in patients treated with PORT alone. Authors concluded that PORT used as first postoperative strategy does not compromise a benefit of POCT and its implementation should be further studied. We discuss the pros and cons of using PORT before POCT for stage IIIA-pN2 NSCLC. Some radiobiological data support earlier use of PORT, however, caution should be paid to not to unnecessarily delay or omit POCT because of its demonstrated survival benefit. Concurrent postoperative radio-chemotherapy could be an attractive approach, but we still have very limited clinical data on its use in this indication.