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 .
Pulmonary resection after concurrent chemotherapy and high dose (60Gy) radiation for non-small cell lung cancer is safe and may provide increased survival.
BACKGROUND We have used doses of 60Gy or higher for neoadjuvant chemoradiotherapy for select patients with advanced non-small cell lung cancer ( NSCLC ) , including patients with N2 disease and those with Pancoast lesions , to avoid gaps in radiotherapy in case surgery is ultimately not offered . METHODS A retrospective cohort study using a prospect i ve data base . Patients underwent initial staging with CT , PET/CT and lymph node biopsy ( mediastinoscopy , endoscopic esophageal ultrasound and endobronchial ultrasound ) and then received neoadjuvant high dose radiotherapy and chemotherapy , followed by thoracotomy with intent to cure . RESULTS Between January 1998 and June 2008 there were 216 patients who were eligible for this study . The median dose of radiation was 60Gy ( range 60 - 72Gy ) . Lobectomy was performed in 152 patients ( 70 % ) about 7 weeks after radiotherapy finished ( mean 51 days , range 34 - 89 days).The bronchus was buttressed with an intercostal muscle flap in 97 % patients . Median hospital stay was 4.5 days ( range 2 - 57 ) . Major morbidity occurred in 17 % . There were five ( 2.3 % ) deaths . There were no bronchial-pleural fistulas after lobectomy , but two occurred after right pneumonectomy . Predictors of morbidity were FEV(1 ) < 50 % ( p<0.001 ) , DLCO < 60 % ( p<0.001 ) and age > 75 years ( p=0.008 ) . The overall 5-year Kaplan-Meier survival was 34 % . It was 42 % for those who underwent R0 resection , 38 % for those with initial N2 disease and 45 % for the 71 complete responders . CONCLUSIONS Pulmonary resection after high dose ( > /=60Gy ) neoadjuvant chemoradiotherapy is safe . Lobectomy can be safely performed and bronchopleural fistula prevented . Sixty Gy allows for maximal medical therapy in case resection is not offered . Since complete response rates may be higher than when 45Gy is used and since surgery is safe , its use deserves further investigation
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 .