ADJUVANT EXTERNAL RADIATION OF THE MEDIASTINUM IN RADICALLY RESECTED NONSMALL CELL LONG CANCER

Objective. The effect of postoperative external beam radiation in MO n on-small cell lung cancer resected with curative intention was evaluat ed in a randomized trial. Methods. In 155 patients (121 males, 34 fema les; mean age: 59 years) 105 lobectomies, 12 bilobectomies and 38 pneu monectomies with radical lymph node dissection to the contra lateral s ide were carried out. Histology revealed squamous cell (n=68), adeno- (n=53), large cell (n=21), adenosquamous (n=6) or bronchioloalveolar t ype (n=7) carcinomas. The pathologic stages T1 (n=38), T2 (n=89), T3 ( n=28); NO (n=39), N1 (n=67), and N2 (n=49) were evenly distributed bet ween the two treatment groups: group A (72 patients) had no further on cologic treatment, while group B (83 patients) had external beam radia tion to the mediastinum (50-56 Gy, 8 or 23 MeV photons, 2 Gy/day, 5 da ys a week) beginning 4 weeks after the operation. Results. The overall 5-year survival rate of the whole collective was 24.1% without any si gnificant difference between the radiotherapy group B (29.7%) and the control group A (20.4%) (log-rank test: P>0.05). The overall 5-year re currence-free survival rate was 20.1%, with no difference between grou ps B and A (radiotherapy: 22.7, controls: 15.6%, log-rank test: P>0.05 ). There was no difference in the incidence of distant metastases (ext ernal beam radiation: n=32; controls: n=38). The rate of local recurre nces at the bronchial stump or in the mediastinum, however, was signif icantly reduced in the radiotherapy group (n=5) compared with 17 in th e controls (P<0.01 chi-square test). A multivariate analysis confirmed the independent influence of postoperative radiotherapy on the incide nce of local recurrence. Conclusions. External radiation of the medias tinum in radically resected non-small cell lung cancer reduces the ris k of local recurrence, but has no influence on distant metastastic spr ead and overall survival.