title: Postoperative radiotherapy for lung cancer: Is it worth the controversy?
abstract: BACKGROUND
  The role of postoperative radiation therapy (PORT) in patients with completely resected non-small cell lung cancer (NSCLC) with pathologically involved mediastinal lymph nodes (N2) remains unclear. Despite a reduction of local recurrence (LR), its effect on overall survival (OS) remains unproven. Therefore we conducted a review of the current literature.
  
  
  METHODS
  To investigate the benefit and safety of modern PORT, we identified published phase III trials for PORT. We investigated modern PORT in low-risk (ypN0/1 and R0) and high-risk (ypN2 and/or R1/2) patients with stage III-N2 NSCLC treated with induction chemotherapy and resection.
  
  
  RESULTS
  Seventeen phase III trials using PORT were selected. Of all PORT N2 studies, 4 were eligible for evaluation of LR, all in high-risk patients only. In these high-risk patients receiving PORT, the mean LR rate at 5years was 20.9% (95% CI 16-24). Two trials were suitable to assess LR rates after chemotherapy and surgery without PORT. In these low-risk patients, the mean 5-year LR was 33.1% (95% CI 27-39). No significant difference in non-cancer deaths between PORT vs. non-PORT patients was observed in N2 NSCLC.
  
  
  CONCLUSIONS
  PORT is worth the controversy because data illustrate that PORT may increase the OS. However, prospective randomized trials are needed to verify this.
authors: KU Leuven - University of Leuven, Department of Radiation Oncology, B-3000 Leuven, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium. Electronic address: charlotte.billiet@jessazh.be.
authors: Charlotte
authors: C
authors: Billiet
authors: KU Leuven - University of Leuven, Department of Radiation Oncology, B-3000 Leuven, Belgium.
authors: Stéphanie
authors: S
authors: Peeters
authors: KU Leuven - University of Leuven, Department of Thoracic Surgery and Leuven Lung Cancer Group, B-3000 Leuven, Belgium.
authors: Herbert
authors: H
authors: Decaluwé
authors: KU Leuven - University of Leuven, Respiratory Oncology Unit (Department of Pneumology) and Leuven Lung Cancer Group, B-3000 Leuven, Belgium.
authors: Johan
authors: J
authors: Vansteenkiste
authors: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium; Department of Medical Oncology, Jessa Hospital, 3500 Hasselt, Belgium.
authors: Jeroen
authors: J
authors: Mebis
authors: KU Leuven - University of Leuven, Department of Radiation Oncology, B-3000 Leuven, Belgium; Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, GROW, Maastricht, The Netherlands.
authors: Dirk De
authors: D
authors: Ruysscher
mesh_terms: D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D015201:Meta-Analysis as Topic; D011182:Postoperative Care / Q000379:methods; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic
keywords: Non-small-cell lung cancer; Post-operative radiotherapy; Review