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 .
A study of postoperative radiotherapy in patients with non-small-cell lung cancer: a randomized trial.
PURPOSE To study the value of postoperative radiotherapy for non-small-cell lung cancer ( NSCLC ) with positive regional lymph metastases ( NI or N2 ) after radical surgery . MATERIAL S AND METHODS From February 1982 to October 1995 , 366 patients with NSCLC and N1 or N2 disease were r and omized into  postoperative radiotherapy ( S + R ) ( 183 patients ) and no further treatment ( S alone ) ( 182 patients ) . Postoperative radiotherapy ( RT ) was administrated 3 - 4 weeks after radical operation . Irradiated fields covered the bronchial stump , ipsilateral hilum , and most of the mediastinum . The midplane dose was 6000 cGy/30 fractions/6 weeks , with the spinal cord limited to 4000 cGy/20 fractions/4 weeks or less . One hundred thirty-four patients in S + R group and 162 patients in S alone group were evaluated . Clinical data were comparable in both arms , except for the numbers of N2 patients . RESULTS The 3-year and 5-year overall survival rates were 51.9 % and 42.9 % in the S + R group and 50.2 % and 40.5 % in the S alone Group ( p = 0.56 ) . The 3-year and 5-year disease-free survival rates were 50.7 % + /- 4.7 % and 42.9 % + /- 5.2 % in the S + R group vs. 44.4 % + /- 4.3 % and 38.2 % + /- 4.5 % in the S alone group ( p = 0.28 ) , respectively . In the patients with NI or T3 - 4 tumors , there was a trend toward improved survival in the S + R group , especially in the patients with T3 - 4N1M0 . These patients demonstrated 20 % improvement in overall survival ( p = 0.092 ) and greater than 20 % better disease-free survival ( p = 0.057 ) . Postoperative RT reduced local recurrence but had no impact on distant metastases . CONCLUSION Postoperative RT significantly reduced local relapses , but did not improve overall survival , due to a high frequency of distant metastases in this patient group
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 .