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 .
Postoperative adjuvant therapy for stage II non-small-cell lung cancer.
BACKGROUND Stage II non-small-cell lung cancer is regarded as one of the early lung cancers . Although resection , including the mediastinal lymph nodes , is currently regarded as the st and ard treatment , the survival rate of this disease is not encouraging . It is well known that the most common causes of death are locoregional recurrences or distant metastases , or both . However , the best adjuvant treatment to improve survival is as controversial an issue as ever . METHODS This study was design ed as a r and omized , blinded , two-armed study with operation and adjuvant radiotherapy in one arm , versus operation and adjuvant mitomycin C ( 10 mg/m2 ) , vinblastine ( 6 mg/m2 ) , and cisplatin ( 100 mg/m2 ) ( MVP ) chemotherapy in the other arm . We assigned 57 resected patients with pathologic proven stage II non-small cell lung cancer to the groups according to our eligibility criteria . RESULTS The most common pattern of recurrence was distant metastases , and nearly all the recurrences ( 17 of 18 patients ) in both groups were found within 2 years after operation . The rates of the locoregional and distant metastases were 3.6 % and 46.4 % in the adjuvant radiotherapy group and 6.9 % and 10.3 % in the adjuvant chemotherapy group ( p = 0.018 ) . The 5-year disease-free survival rates were 52.0 % in the adjuvant radiotherapy group and 74.0 % in the adjuvant chemotherapy group ( p = 0.16 , log-rank test ) . The 2-year , 5-year , and 6-year survival portions were 60.3 % , 56.5 % , and 28.3 % in the adjuvant radiotherapy group , and 82.8 % , 70.1 % , and 60.1 % in the adjuvant chemotherapy group ( p = 0.01 , p = 0.17 , and p = 0.03 , Z-test ) . The difference of the actuarial survival between these two groups was somewhat significant ( p = 0.09 , log-rank test ) . CONCLUSIONS Our results suggest that the addition of adjuvant MVP chemotherapy may reduce the distant metastasis rates and prolong the survival of the surgically resected stage II non-small-cell lung cancer patients
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 .