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Review
. 2022 Mar 23;14(7):1617.
doi: 10.3390/cancers14071617.

Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer-A Review

Krisztian Süveg  1 , Ludwig Plasswilm  1   2 , Thomas Iseli  1 , Pawel Leskow  3 , Galina Farina Fischer  4 , Paul Martin Putora  1   2
Affiliations
Review

Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer-A Review

Krisztian Süveg et al. Cancers (Basel). .

Abstract

Background: For patients with completely resected non-small cell lung cancer (NSCLC) with ipsilateral mediastinal lymph node involvement (pN2), the administration of adjuvant chemotherapy is the standard of care. The role of postoperative radiation therapy (PORT) is controversial.

Methods: We describe the current literature focusing on the role of PORT in completely resected NSCLC patients with pN2 involvement and reflect on its role in current guidelines.

Results: Based on the results of the recent Lung ART and PORT-C trials, the authors conclude that PORT cannot be generally recommended for all resected pN2 NSCLC patients. A substantial decrease in the locoregional relapse rate without translating into a survival benefit suggests that some patients with risk factors might benefit from PORT. This must be balanced against the risk of cardiopulmonary toxicity with potentially associated mortality. Lung ART has already changed the decision making for the use of PORT in daily practice for many European lung cancer experts, with lower rates of recommendations for PORT overall.

Conclusions: PORT is still used, albeit decreasingly, for completely resected NSCLC with pN2 involvement. High-level evidence for its routine use is lacking. Further analyses are required to identify patients who would potentially benefit from PORT.

Keywords: NSCLC; PORT; radiation therapy; resection; risk factors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Illustration of RT planning of PORT for a completely resected NSCLC patient with histologically proven lymph nodes (2/9) in stations 7 and 10R in (a) coronal and (b) sagittal views. Delineation based on the Lung ART protocol of rCTV (orange): bronchial stump, ipsilateral hilar node region (10R) and lymph node station 7. CTV (pink): rCTV+1 cm. In this case, 4R, 7 and 10R had a maximal upper limit to the top of the aortic arc and a maximal lower limit 5 cm below the carina. PTV (red); (c) color wash of dose distribution ranging from 20 Gy to 57.7 Gy (prescribed dose: 54 Gy). rCTV: resected clinical tumor volume, CTV: clinical tumor volume, PTV: planning target volume.
See this image and copyright information in PMC

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