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 .
Radiation therapy oncology group protocol 02-29: a phase II trial of neoadjuvant therapy with concurrent chemotherapy and full-dose radiation therapy followed by surgical resection and consolidative therapy for locally advanced non-small cell carcinoma of the lung.
PURPOSE To evaluate mediastinal nodal clearance ( MNC ) rates after induction chemotherapy and concurrent , full-dose radiation therapy ( RT ) in a phase II trimodality trial ( Radiation Therapy Oncology Group protocol 0229 ) . PATIENTS AND METHODS Patients ( n=57 ) with stage III non-small cell lung cancer ( pathologically proven N2 or N3 ) were eligible .  Induction chemotherapy consisted of weekly carboplatin ( AUC = 2.0 ) and paclitaxel 50 mg/m(2 ) . Concurrent RT was prescribed , with 50.4 Gy to the mediastinum and primary tumor and a boost of 10.8 Gy to all gross disease . The mediastinum was pathologically reassessed after completion of chemoradiation . The primary endpoint of the study was MNC , with secondary endpoints of 2-year overall survival and postoperative morbidity/mortality . RESULTS The grade 3/4 toxicities included hematologic 35 % , gastrointestinal 14 % , and pulmonary 23 % . Forty-three patients ( 75 % ) were evaluable for the primary endpoint . Twenty-seven patients achieved the primary endpoint of MNC ( 63 % ) . Thirty-seven patients underwent resection . There was a 14 % incidence of grade 3 postoperative pulmonary complications and 1 30-day , postoperative grade 5 toxicity ( 3 % ) . With a median follow-up of 24 months for all patients , the 2-year overall survival rate was 54 % , and the 2-year progression-free survival rate was 33 % . The 2-year overall survival rate was 75 % for those who achieved nodal clearance , 52 % for those with residual nodal disease , and 23 % for those who were not evaluable for the primary endpoint ( P=.0002 ) . CONCLUSIONS This multi-institutional trial confirms the ability of neoadjuvant concurrent chemoradiation with full-dose RT to sterilize known mediastinal nodal 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 .