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 .
The role of post-operative radiotherapy in non-small-cell lung cancer: a multicentre randomised trial in patients with pathologically staged T1-2, N1-2, M0 disease. Medical Research Council Lung Cancer Working Party.
The role of post-operative radiotherapy for patients with non-small-cell lung cancer ( NSCLC ) is unclear despite five previous r and omised trials . One deficiency with these trials was that they did not include adequate TNM staging , and so the present r and omised trial was design ed to compare surgery alone ( S ) with surgery plus post-operative radiotherapy ( SR ) in patients with pathologically staged T1 - 2 , N1 - 2 . M0 NSCLC . Between July 1986 and October 1993 , 308 patients ( 154 S , 154 SR ) were entered from 16 centres in the UK . The median age of the patients was 62 years , 74 % were male , > 85 % had normal or near normal levels of general condition , activity and breathlessness , 68 % had squamous carcinoma , 52 % had had a pneumonectomy , 63 % had N1 disease and 37 % N2 disease . SR patients received 40 Gy in 15 fractions starting 4 - 6 weeks post-operatively . Overall there was no advantage to either group in terms of survival , although definite local recurrence and bony metastases appeared less frequently and later in the SR group . In a subgroup analysis , in the N1 group no differences between the treatment groups were seen , but in the N2 group SR patients appeared to gain a one month survival advantage , delayed time to local recurrence and time to appearance of the bone metastases . There is , therefore , no clear indication for post-operative radiotherapy in N1 disease , but the question remains unresolved in N2 disease
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 .