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 radiotherapy in radically resected non-small cell lung cancer.
PURPOSE To evaluate the value of adjuvant postoperative external-beam radiation ( EBR ) in patients with radically resected non-small cell lung cancer ( NSCLC ) pT1 - 3 pN0 - 2 compared to patients with resected NSCLC without adjuvant EBR . MATERIAL S AND METHODS In 155 patients ( 121 male , 34 female ; mean age , 59 years ) 105 lobectomies , 12 bilobectomies , and 38 pneumonectomies with radical lymph node dissection of the contralateral [ corrected ] side were performed . Postoperative staging was done according to the TNM system and was as follows : pT1 ( n=38 ) , pT2 ( n=89 ) , pT3 ( n=28 ) ; pN0 ( n=39 ) , pN1 ( n=67 ) and pN2 ( n=49 ) . Histopathologic study revealed 68 squamous cell carcinomas , 53 adenocarcinomas , 21 large cell carcinomas , 6 adenosquamous cell carcinomas , and 7 bronchioloalveolar cell carcinomas . All patients were r and omly assigned into two treatment groups : 72 patients with no further treatment ( control group ) , and 83 patients ( EBR group ) with adjuvant postoperative EBR of the bronchial stump and mediastinum ( 50 to 56 Gy , 8 or 23 MV photons , 2 Gy/d , 5 d/wk ) beginning 4 to 6 weeks after surgery . RESULTS The overall 5-year survival rate ( median observation time , 43 months ) of all patients was 24.1 % ( EBR group , 29.7 % ; control group , 20.4 % ; p>0.05 , not significant ) . The relative risk of the EBR group was 0.85 with a two-sided confidence interval of 0.66 to 1.09 . The overall 5-year recurrence-free survival was 20.6 % ( EBR , 27.1 % ; control group , 15.6 % ; p=0.07 ) . The relative risk of the EBR group was 0.80 with a confidence interval of 0.63 to 1.01 . The rate of local recurrences at the bronchial stump and /or mediastinum was significantly smaller in the EBR group ( n=5 ) than in the control group ( n=17 ) ( p<0.01 ) . Multivariate analysis ( chi2 test ) demonstrated an independent influence of postoperative EBR on the incidence of local recurrences . The incidence of distant metastases was slightly but not significantly higher in patients without EBR ( 38 patients ) compared to those who had EBR ( 32 patients ) . CONCLUSION High-dose postoperative EBR to the mediastinum significantly reduces the risk of local recurrence at the bronchial stump and /or mediastinum . Age , sex , histologic subtype , tumor size , surgical approach , or extent of lymph node involvement had no prognostic value -- only postoperative EBR had an independent influence on the risk of local recurrence . The effect of postoperative EBR was on the verge of significance with respect to recurrence-free survival and showed the same tendency in overall survival , however with an attenuated relative risk
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 .