Postoperative radiation therapy for patients who have resected non-small cell lung cancer

The role of adjuvant postoperative therapy for patients who have resected non-small cell lung cancer (NSCLC) has been controversial. Recent large trials and meta-analysis support a modest, but significant, survival benefit for postoperative adjuvant chemotherapy. Postoperative radiation therapy has little potential benefit in patients who have N₀ or N₁ disease and should not be used routinely in these patients. There are suggestions of benefit for patients who have N₂ disease, but adequately powered trials have not been conducted to demonstrate a possible small, but clinically worthwhile, survival benefit in this subgroup. Central nervous system relapse has emerged as an increasing problem for patients who have NSCLC; trials of prophylactic cranial irradiation are underway in several cooperative trial groups.