RESULTS For patients who have undergone surgical resection , high-level evidence suggests that use of postoperative RT does not influence survival , but optimizes local control for patients with N2 involvement , and its use in the setting of positive margins or gross primary /nodal residual disease is recommended .
No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy ; however , modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized .
PURPOSE To provide guidance to physicians and patients with regard to the use of adjuvant external beam radiation therapy ( RT ) in locally advanced non-small cell lung cancer ( LA NSCLC ) based on available medical evidence complemented by consensus-based expert opinion .
Long-term results of the international adjuvant lung cancer trial evaluating adjuvant Cisplatin-based chemotherapy in resected lung cancer.
PURPOSE Based on 5-year or shorter-term follow-up data in recent r and omized trials , adjuvant cisplatin-based chemotherapy is now generally recommended after complete surgical resection for patients with non-small-cell lung cancer ( NSCLC ) . We evaluated the results of the International Adjuvant Lung Cancer Trial study with three additional years of follow-up . PATIENTS AND METHODS Patients with completely resected NSCLC were r and omly assigned to three or four cycles of cisplatin-based chemotherapy or to observation . Cox models were used to evaluate treatment effect according to follow-up duration . Results The trial included 1,867 patients with a median follow-up of 7.5 years . Results showed a beneficial effect of adjuvant chemotherapy on overall survival ( hazard ratio [ HR ] , 0.91 ; 95 % CI , 0.81 to 1.02 ; P = .10 ) and on disease-free survival ( HR , 0.88 ; 95 % CI , 0.78 to 0.98 ; P = .02 ) . However , there was a significant difference between the results of overall survival before and after 5 years of follow-up ( HR , 0.86 ; 95 % CI , 0.76 to 0.97 ; P = .01 v HR , 1.45 ; 95 % CI , 1.02 to 2.07 ; P = .04 ) with P = .006 for interaction . Similar results were observed for disease-free survival . The analysis of non-lung cancer deaths for the whole period showed an HR of 1.34 ( 95 % CI , 0.99 to 1.81 ; P = .06 ) . CONCLUSION These results confirm the significant efficacy of adjuvant chemotherapy at 5 years . The difference in results beyond 5 years of follow-up underscores the need for the long-term follow-up of other adjuvant lung cancer trials and for a better identification of patients deriving long-term benefit from adjuvant chemotherapy
RESULTS For patients who have undergone surgical resection , high-level evidence suggests that use of postoperative RT does not influence survival , but optimizes local control for patients with N2 involvement , and its use in the setting of positive margins or gross primary /nodal residual disease is recommended .
No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy ; however , modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized .
PURPOSE To provide guidance to physicians and patients with regard to the use of adjuvant external beam radiation therapy ( RT ) in locally advanced non-small cell lung cancer ( LA NSCLC ) based on available medical evidence complemented by consensus-based expert opinion .