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 .
Effect of preoperative chemoradiation in addition to preoperative chemotherapy: a randomised trial in stage III non-small-cell lung cancer.
BACKGROUND Preoperative chemotherapy improves survival in patients with stage III non-small-cell lung cancer ( NSCLC ) amenable to resection . We aim ed to assess the additional effect of preoperative chemoradiation on tumour resection , pathological response , and survival in these patients . METHODS Between Oct 1 , 1995 , and July 1 , 2003 , patients with stage IIIA-IIIB NSCLC and invasive mediastinal assessment from 26 participating institutions of the German Lung Cancer Cooperative Group ( GLCCG ) were r and omly assigned to one of two treatment groups . The intervention group were scheduled to receive three cycles of cisplatin and etoposide , followed by twice-daily radiation with concurrent carboplatin and vindesine , and then surgical resection ( those with positive resection margins or unresectable disease were offered further twice-daily radiotherapy ) . The control group were scheduled to receive three cycles of cisplatin and etoposide , followed by surgery , and then further radiotherapy . The primary endpoint was median progression-free survival ( PFS ) in patients eligible for treatment after r and omisation . Secondary endpoints in patients eligible for treatment after r and omisation were overall survival ( OS ) and the proportion of patients undergoing surgery . Secondary endpoints in patients with tumour resection were the proportion with negative resection margins , the proportion with complete resection , the proportion with histopathological response , and the proportion with mediastinal downstaging . Additionally , exploratory ( not prespecified ) post-hoc analyses in terms of PFS and OS were done on patients not amenable to resection and on further subgroups of patients undergoing resection . Analyses were by intention to treat . This trial is registered on the Clinical Trials.gov website , number NCT 00176137 . FINDINGS 558 patients were r and omly assigned . 34 patients did not meet inclusion criteria and were excluded . Of 524 eligible patients , 142 of 264 ( 54 % ) in the interventional group and 154 of 260 ( 59 % ) in the control group underwent surgery ; 98 of 264 ( 37 % ) and 84 of 260 ( 32 % ) underwent complete resection . In patients with complete resection , the proportion of those with mediastinal downstaging ( 45 of 98 [ 46 % ] and 24 of 84 [ 29 % ] , p=0.02 ) and pathological response ( 59 of 98 [ 60 % ] and 17 of 84 [ 20 % ] , p<0.0001 ) favoured the interventional group . However , there was no difference in PFS ( primary endpoint ) between treatment groups-either in eligible patients ( median PFS 9.5 months , range 1.0 - 117.0 [ 95 % CI 8.3 - 11.2 ] vs 10.0 months , range 1.0 - 111.0 [ 8.9 - 11.5 ] , 5-year PFS 16 % [ 11 - 21 ] vs 14 % [ 10 - 19 ] , hazard ratio ( HR ) 0.99 [ 0.81 - 1.19 ] , p=0.87 ) , in those undergoing tumour resection , or in patients with complete resection . In both groups , 35 % of patients undergoing surgery received a  pneumonectomy  ( 50/142 vs 54/154 ) . In patients receiving a pneumonectomy , treatment-related mortality increased in the interventional group compared with the control group ( 7/50 [ 14 % ] vs 3/54 [ 6 % ] ) . INTERPRETATION In patients with stage III NSCLC amenable to surgery , preoperative chemoradiation in addition to chemotherapy increases pathological response and mediastinal downstaging , but does not improve survival . After induction with chemoradiation , pneumonectomy should be avoided . FUNDING German Cancer Aid ( Bonn , Germany )
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 .