• Adjuvant therapy detrimental in stage I,II and N0,N1 patients
  • No adverse effect in stage III, N2 patients
  • MRC trend toward improved LRC and OS.
  • SEER database review showed increase in survival in PORT for N2 but not N1 or N0[1]

LCSG 773

  • LCSG 773: In N2 disease, significant reduction in overall recurrence which did not translate into OS.

Indications for PORT

  • Margin (+): while effectiveness of PORT has not been proven, most experts recommends its use.
  • ECE (+): xrt may be treated per “experts” (Keller ECOG 3590)
  • pN2, margin(-) can be treated with XRT or chemoradiation (NCCN). Multiple nodal stations or accordant tumor spread may benefit most. (Sawyer)

Treatment dose and field (Keller ECOG 3590)

  • 5040 cGy at 1.8 Gy per fraction
  • Boost nodal station with ECE by 10.8 Gy, 1.8 Gy per fraction

Post-operative chemotherapy

  • ECOG 3590 was negative for post-operative chemotherapy
    • Median survival 39 mo[RT] and 38 mo[CRT]
  • Meta-analysis of 14 trials showed chemotherapy in conjunction with surgery lead to 5% 5-OS advantage.(NSCLC Collaborative Group)
1. Lally BE, Zelterman D, Colasanto JM, Haffty BG, Detterbeck FC, Wilson LD. Postoperative radiotherapy for stage II or III non-small-cell lung cancer using the surveillance, epidemiology, and end results database. J Clin Oncol. 2006 Jul 1;24(19):2998-3006. Epub 2006 Jun 12.
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