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Role of postoperative radiotherapy in resected non-small cell lung cancer: a reassessment based on new data - PubMed

Review

Role of postoperative radiotherapy in resected non-small cell lung cancer: a reassessment based on new data

Cécile Le Péchoux. Oncologist. 2011.

Abstract

In completely resected non-small cell lung cancer (NSCLC) patients with pathologically involved mediastinal lymph nodes (N2), administration of adjuvant platinum-based chemotherapy is now considered the standard of care, based on level 1 evidence. The role of postoperative radiation therapy (PORT) in this group of patients remains controversial. The PORT meta-analysis published in 1998 concluded that adjuvant radiotherapy was detrimental to patients with early-stage completely resected NSCLC, but that the role of PORT in the treatment of tumors with N2 involvement was unclear, and that further research was warranted. Recent retrospective and nonrandomized studies, as well as subgroup analyses of recent randomized trials evaluating adjuvant chemotherapy, provide evidence of the possible benefit of PORT in patients with mediastinal nodal involvement. The role of PORT is also a valid question in patients with proven N2 disease who have undergone only induction chemotherapy followed by surgery, because the local recurrence rate for such patients varies in the range of 20%-60%. Based on the currently available data, PORT should be discussed for fit patients with completely resected NSCLC with N2 nodal involvement, preferably after completion of adjuvant chemotherapy. There is a need for new randomized evidence to evaluate PORT using the modern three-dimensional conformal radiation technique, with attention paid to reducing the risk for, particularly, pulmonary and cardiac toxicity. A new large multi-institutional randomized trial evaluating PORT in this patient population is needed and now under way.

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Conflict of interest statement

Disclosures

Cécile Le Péchoux: None.

Section Editor Suresh Senan discloses a consulting relationship with Lilly and Varian Medical Systems; honoraria received from Varian Medical Systems, Roche, and AstraZeneca, and research funding received from Varian Medical Systems.

Section Editor Andrew Turrisi discloses no financial relationships.

Reviewers “A” and “B” disclose no financial relationships.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. On the basis of disclosed information, all conflicts of interest have been resolved.

Figures

Figure 1.
Figure 1.

Lung Adjuvant Radiotherapy Trial (ART) design. Abbreviations: CT, computed tomography; DFS, disease-free survival; NSCLC, non-small cell lung cancer; PET, positron emission tomography; PORT, postoperative radiation therapy; post-op, postoperative; pre-op, preoperative; SCC, squamous cell carcinoma.

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