Institut Gustave Roussy, Radiotherapy Department, Villejuif 94800, France.
Oncologist. 2011;16(5):672-81. doi: 10.1634/theoncologist.2010-0150. Epub 2011 Mar 4.
In completely resected non-small cell lung cancer (NSCLC) patients with pathologically involved mediastinal lymph nodes (N2), administration of adjuvant platinum-based chemotherapy is now considered the standard of care, based on level 1 evidence. The role of postoperative radiation therapy (PORT) in this group of patients remains controversial. The PORT meta-analysis published in 1998 concluded that adjuvant radiotherapy was detrimental to patients with early-stage completely resected NSCLC, but that the role of PORT in the treatment of tumors with N2 involvement was unclear, and that further research was warranted. Recent retrospective and nonrandomized studies, as well as subgroup analyses of recent randomized trials evaluating adjuvant chemotherapy, provide evidence of the possible benefit of PORT in patients with mediastinal nodal involvement. The role of PORT is also a valid question in patients with proven N2 disease who have undergone only induction chemotherapy followed by surgery, because the local recurrence rate for such patients varies in the range of 20%-60%. Based on the currently available data, PORT should be discussed for fit patients with completely resected NSCLC with N2 nodal involvement, preferably after completion of adjuvant chemotherapy. There is a need for new randomized evidence to evaluate PORT using the modern three-dimensional conformal radiation technique, with attention paid to reducing the risk for, particularly, pulmonary and cardiac toxicity. A new large multi-institutional randomized trial evaluating PORT in this patient population is needed and now under way.
在完全切除的非小细胞肺癌（NSCLC）患者中，病理上有纵隔淋巴结（N2）受累，根据 1 级证据，现在认为辅助铂类化疗是标准治疗。术后放疗（PORT）在这组患者中的作用仍存在争议。1998 年发表的 PORT 荟萃分析得出结论，辅助放疗对早期完全切除的 NSCLC 患者有害，但 PORT 在 N2 受累肿瘤治疗中的作用尚不清楚，需要进一步研究。最近的回顾性和非随机研究，以及最近评估辅助化疗的随机试验的亚组分析，提供了 PORT 可能对纵隔淋巴结受累患者有益的证据。在仅接受诱导化疗然后手术的已证实 N2 疾病患者中，PORT 的作用也是一个合理的问题，因为此类患者的局部复发率在 20%-60%之间。基于目前可用的数据，对于有 N2 淋巴结受累的完全切除的 NSCLC 且身体状况适合的患者，应考虑 PORT，最好在辅助化疗完成后进行。需要新的随机证据来评估使用现代三维适形放疗技术的 PORT，特别要注意降低肺和心脏毒性的风险。需要并正在进行一项新的大型多机构随机试验，以评估该患者人群中的 PORT。
