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. 1996 Aug;74(4):632–639. doi: 10.1038/bjc.1996.413

The role of post-operative radiotherapy in non-small-cell lung cancer: a multicentre randomised trial in patients with pathologically staged T1-2, N1-2, M0 disease. Medical Research Council Lung Cancer Working Party.

R J Stephens 1, D J Girling 1, N M Bleehen 1, K Moghissi 1, H M Yosef 1, D Machin 1
PMCID: PMC2074683  PMID: 8761382

Abstract

The role of post-operative radiotherapy for patients with non-small-cell lung cancer (NSCLC) is unclear despite five previous randomised trials. One deficiency with these trials was that they did not include adequate TNM staging, and so the present randomised trial was designed to compare surgery alone (S) with surgery plus post-operative radiotherapy (SR) in patients with pathologically staged T1-2, N1-2. M0 NSCLC. Between July 1986 and October 1993, 308 patients (154 S, 154 SR) were entered from 16 centres in the UK. The median age of the patients was 62 years, 74% were male, > 85% had normal or near normal levels of general condition, activity and breathlessness, 68% had squamous carcinoma, 52% had had a pneumonectomy, 63% had N1 disease and 37% N2 disease. SR patients received 40 Gy in 15 fractions starting 4-6 weeks post-operatively. Overall there was no advantage to either group in terms of survival, although definite local recurrence and bony metastases appeared less frequently and later in the SR group. In a subgroup analysis, in the N1 group no differences between the treatment groups were seen, but in the N2 group SR patients appeared to gain a one month survival advantage, delayed time to local recurrence and time to appearance of the bone metastases. There is, therefore, no clear indication for post-operative radiotherapy in N1 disease, but the question remains unresolved in N2 disease.

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Selected References

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  1. Choi N. C., Grillo H. C., Gardiello M., Scannell J. G., Wilkins E. W., Jr Basis for new strategies in postoperative radiotherapy of bronchogenic carcinoma. Int J Radiat Oncol Biol Phys. 1980 Jan;6(1):31–35. doi: 10.1016/0360-3016(80)90199-6. [DOI] [PubMed] [Google Scholar]
  2. Chung C. K., Stryker J. A., O'Neill M., Jr, DeMuth W. E., Jr Evaluation of adjuvant postoperative radiotherapy for lung cancer. Int J Radiat Oncol Biol Phys. 1982 Nov;8(11):1877–1880. doi: 10.1016/0360-3016(82)90444-8. [DOI] [PubMed] [Google Scholar]
  3. Edwards F. R. Use of BCG as an immunostimulant after resection of carcinoma of the lung: a two-year assessment of a trial of 500 patients. Thorax. 1979 Dec;34(6):801–806. doi: 10.1136/thx.34.6.801. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Goldstraw P., Kurzer M., Edwards D. Preoperative staging of lung cancer: accuracy of computed tomography versus mediastinoscopy. Thorax. 1983 Jan;38(1):10–15. doi: 10.1136/thx.38.1.10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Green N., Kurohara S. S., George F. W., 3rd, Crews Q. E., Jr Postresection irradiation for primary lung cancer. Radiology. 1975 Aug;116(02):405–407. doi: 10.1148/116.2.405. [DOI] [PubMed] [Google Scholar]
  6. Greschuchna D., Maassen W. The importance of histological classification and tumor staging for prognosis after resection of bronchial carcinoma. Thorac Cardiovasc Surg. 1980 Apr;28(2):115–119. doi: 10.1055/s-2007-1022061. [DOI] [PubMed] [Google Scholar]
  7. Kirsh M. M., Rotman H., Argenta L., Bove E., Cimmino V., Tashian J., Ferguson P., Sloan H. Carcinoma of the lung: results of treatment over ten years. Ann Thorac Surg. 1976 May;21(5):371–377. doi: 10.1016/s0003-4975(10)63881-7. [DOI] [PubMed] [Google Scholar]
  8. Lewis J. A., Machin D. Intention to treat--who should use ITT? Br J Cancer. 1993 Oct;68(4):647–650. doi: 10.1038/bjc.1993.402. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Matthews M. J., Kanhouwa S., Pickren J., Robinette D. Frequency of residual and metastatic tumor in patients undergoing curative surgical resection for lung cancer. Cancer Chemother Rep 3. 1973 Mar;4(2):63–67. [PubMed] [Google Scholar]
  10. Mountain C. F. A new international staging system for lung cancer. Chest. 1986 Apr;89(4 Suppl):225S–233S. doi: 10.1378/chest.89.4_supplement.225s. [DOI] [PubMed] [Google Scholar]
  11. Naruke T., Suemasu K., Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg. 1978 Dec;76(6):832–839. [PubMed] [Google Scholar]
  12. Newman S. B., DeMeester T. R., Golomb H. M., Hoffman P. C., Little A. G., Raghavan V. Treatment of modified Stage II (T1 N1 M0, T2 N1 M0) non-small cell bronchogenic carcinoma. A combined modality approach. J Thorac Cardiovasc Surg. 1983 Aug;86(2):180–185. [PubMed] [Google Scholar]
  13. PATERSON R., RUSSELL M. H. Clinical trials in malignant disease. IV-Lung cancer. value of post-operative radiotherapy. Clin Radiol. 1962 Apr;13:141–144. doi: 10.1016/s0009-9260(62)80036-1. [DOI] [PubMed] [Google Scholar]
  14. Pearson F. G. Use of mediastinoscopy in selection of patients for lung cancer operations. Ann Thorac Surg. 1980 Sep;30(3):205–207. doi: 10.1016/s0003-4975(10)61245-3. [DOI] [PubMed] [Google Scholar]
  15. Perez C. A. Is postoperative irradiation indicated in carcinoma of the lung? Int J Radiat Oncol Biol Phys. 1982 Nov;8(11):2019–2022. doi: 10.1016/0360-3016(82)90465-5. [DOI] [PubMed] [Google Scholar]
  16. Rosell R., Maestre J., Font A., Moreno I., Molina F., Milla A., Gómez-Codina J., Camps C. A randomized trial of mitomycin/ifosfamide/cisplatin preoperative chemotherapy plus surgery versus surgery alone in stage IIIA non-small cell lung cancer. Semin Oncol. 1994 Jun;21(3 Suppl 4):28–33. [PubMed] [Google Scholar]
  17. Spiro S., Goldstraw P. The staging of lung cancer. Thorax. 1984 Jun;39(6):401–407. doi: 10.1136/thx.39.6.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Van Houtte P., Rocmans P., Smets P., Goffin J. C., Lustman-Maréchal J., Vanderhoeft P., Henry J. Postoperative radiation therapy in lung caner: a controlled trial after resection of curative design. Int J Radiat Oncol Biol Phys. 1980 Aug;6(8):983–986. doi: 10.1016/0360-3016(80)90105-4. [DOI] [PubMed] [Google Scholar]
  19. Wilkins E. W., Jr, Scannell J. G., Craver J. G. Four decades of experience with resections for bronchogenic carcinoma at the Massachusetts General Hospital. J Thorac Cardiovasc Surg. 1978 Sep;76(3):364–368. [PubMed] [Google Scholar]

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