| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
1 From the Department of Radiotherapy, University Medical School of Graz, Austria
2 From the Department of Thoracic and Hyperbaric Surgery, University Medical School of Graz, Austria
3 From the Department of Radiodiagnosis, University Medical School of Graz, Austria
4 From the Medical Informatics, Statistics and Documentation, University Medical School of Graz, Austria
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.
Materials 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 ipsilateral 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 randomly 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 (
2 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.
Key Words: lung cancer • postoperative radiotherapy • lung cancer • recurrence • lung cancer • surgery • lung cancer • survival
Submitted on September 17, 1996
Accepted on March 2, 1997
This article has been cited by other articles:
|
|
 |
|
  B. E. Lally, D. Zelterman, J. M. Colasanto, B. G. Haffty, F. C. Detterbeck, and L. D. Wilson Postoperative Radiotherapy for Stage II or III Non-Small-Cell Lung Cancer Using the Surveillance, Epidemiology, and End Results Database J. Clin. Oncol., July 1, 2006; 24(19): 2998 - 3006. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Bonner and S. A. Spencer Postoperative Radiotherapy in Non--Small-Cell Lung Cancer Warrants Further Exploration in the Era of Adjuvant Chemotherapy and Conformal Radiotherapy J. Clin. Oncol., July 1, 2006; 24(19): 2978 - 2980. [Full Text] [PDF]
|
|
|
|
 |
|
 L. W. Martin, A. M. Correa, W. Hofstetter, W. K. Hong, R. Komaki, J. B. Putnam Jr, D. C. Rice, W. R. Smythe, S. G. Swisher, A. A. Vaporciyan, et al. The evolution of treatment outcomes for resected stage IIIA non-small cell lung cancer over 16 years at a single institution J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1601 - 1610. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Bogart and J. N. Aronowitz Localized Non-Small Cell Lung Cancer: Adjuvant Radiotherapy in the Era of Effective Systemic Therapy Clin. Cancer Res., July 1, 2005; 11(13): 5004s - 5010s. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Barlesi, C. Doddoli, C. Gimenez, B. Chetaille, R. Giudicelli, P. Fuentes, J.-P. Kleisbauer, and P. Thomas Bronchioloalveolar carcinoma: myths and realities in the surgical management Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 159 - 164. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Price Lung cancer * 5: State of the art radiotherapy for lung cancer Thorax, May 1, 2003; 58(5): 447 - 452. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Cykert and N. Phifer Surgical Decisions for Early Stage, Non-Small Cell Lung Cancer: Which Racially Sensitive Perceptions of Cancer Are Likely to Explain Racial Variation in Surgery? Med Decis Making, March 1, 2003; 23(2): 167 - 176. [Abstract] [PDF]
|
|
|
|
 |
|
 W. J. Scott, J. Howington, and B. Movsas Treatment of Stage II Non-small Cell Lung Cancer Chest, January 1, 2003; 123(1_suppl): 188S - 201S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Keller, S. Adak, H. Wagner, A. Herskovic, R. Komaki, B. J. Brooks, M. C. Perry, R. B. Livingston, D. H. Johnson, and The Eastern Cooperative Oncology Group A Randomized Trial of Postoperative Adjuvant Therapy in Patients with Completely Resected Stage II or IIIa Non-Small-Cell Lung Cancer N. Engl. J. Med., October 26, 2000; 343(17): 1217 - 1222. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
