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European Journal of Cardio-Thoracic Surgery, Vol 10, 947-950, Copyright © 1996 by European Association for Cardio-thoracic Surgery
FM Smolle-Juettner, R Mayer, H Pinter, G Stuecklschweiger, KS Kapp, S Gabor, B Ratzenhofer, A Hackl and G Friehs
OBJECTIVE: The effect of postoperative external beam radiation in MO
non-small cell lung cancer resected with curative intention was evaluated
in a randomized trial. METHODS: In 155 patients (121 males, 34 females;
mean age: 59 years) 105 lobectomies, 12 bilobectomies and 38
pneumonectomies with radical lymph node dissection to the contralateral
side were carried out. Histology revealed squamous cell (n = 68), adeno- (n
= 53), large cell (n = 21), adenosquamous (n = 6) or bronchioloalveolar
type (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
between the two treatment groups: group A (72 patients) had no further
oncologic treatment, while group B (83 patients) had external beam
radiation to the mediastinum (50-56 Gy, 8 or 23 MeV photons, 2 Gy/day, 5
days a week) beginning 4 weeks after the operation. RESULTS: The overall
5-year survival rate of the whole collective was 24.1% without any
significant 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
recurrence-free survival rate was 20.1%, with no difference between groups
B and A (radiotherapy: 22.7, controls: 15.6%, long-rank test: P > 0.05).
There was no difference in the incidence of distant metastases (external
beam radiation: n = 32; controls: n = 38). The rate of local recurrences at
the bronchial stump or in the mediastinum, however, was significantly
reduced in the radiotherapy group (n = 5) compared with 17 in the controls
(P < 0.01 chi-square test). A multivariate analysis confirmed the
independent influence of postoperative radiotherapy on the incidence of
local recurrence. CONCLUSIONS: External radiation of the mediastinum in
radically resected non-small cell lung cancer reduces the risk of local
recurrence, but has no influence on distant metastastic spread and overall
survival.
ARTICLES
"Adjuvant" external radiation of the mediastinum in radically resected non-small cell lung cancer
Department of Thoracic and Hyperbaric Surgery, University of Graz, Austria.
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