Lung adjuvant radiotherapy trial art

Overall survival at three years was This must be put into balance with the risk of over-added cardio-pulmonary toxicity. Prof Rafal Dziadziuszko, radiation oncologist from the Medical University of Gdansk, Poland, commented on the findings.

This will change the practice of many institutions that adopted standard use of radiotherapy in these patients. We can safely say there is no net benefit from such treatment but there is also potential harm, which we see from this study, so any potential benefits in some patients are offset by the predominantly higher risk of cardiopulmonary toxicities.

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Le Pechoux 1 , N. Pourel 2 , F. Barlesi 3 , C. Faivre-Finn 4 , D. Lerouge 5 , G. Zalcman 6 , D. Antoni 7 , B. Lamezec 8 , U. Nestle 9 , P. Boisselier 10 , F. Thillays 11 , A. Paumier 12 , E.

Dansin 13 , K. Peignaux 14 , J. Madelaine 15 , E. Pichon 16 , A. Larrouy 17 , O. Riesterer 18 , A. In case of pre-operative chemotherapy, the ipsilateral mediastinal involvement has to be pathologically proven before any treatment, so that even in case of mediastinal downstaging N2 to N1 or N0 , the patient can enter the study. Even if induction chemotherapy produces a good response, up to one third of these patients may eventually suffer from local relapse 64 , thus it seems interesting to evaluate PORT in this subgroup of patients.

There has been a proposal for the definition of complete resection by a group of surgeons of the IASLC Lymph node exploration is mandatory, however the surgeon might choose to use either a simple node sampling or a complete systematic nodal dissection, because the role of these 2 approaches is still debated 66 - Three-dimensional conformal radiotherapy is, of course, mandatory, together with the use of high-energy photon MV delivered by a linear accelerator.

The planned total dose is 54 Gy 37 in fractions of 1. Elective nodal irradiation, which means to treat the whole mediastinum, including the ipsi and contra lateral side of the mediastinum down to the pillars of the diaphragm, and the supra clavicular areas, is not allowed.

Treated volume is now limited to involved node station s and stations at high risk according to tumor location 40 , 41 , This contouring protocol has been evaluated and was able to reduce variability of the treated volume among clinicians Quality assurance procedures, such as a dummy run before any inclusion in a center, aim to verify the compliance to the Lung ART protocol volume definition, dose to organ at risk, etc.

The main end point of this study is disease free survival DFS Another trial is on going in China comparing 4 cycles of adjuvant chemotherapy to 4 cycles of chemotherapy followed by radiotherapy, after complete resection of NSCLC. Lung adjuvant radiotherapy trial ART design. In the pre-PET era, the high rate of distant metastases diluted any real effect of local control on overall outcome.

As the population of resected N2 patients has changed, because of better selection more accurate staging with PET CT, brain imaging , better surgery lung sparing techniques, pre-op and post-op care… , administration of systematic adjuvant or neo-adjuvant chemotherapy which has become standard of care, the major technical advances of radiotherapy may enhance the ability of PORT to improve local relapse free survival and possibly overall survival but this has to be proven.

The results of these randomized trials could change the standard care in resected N2 patients. National Center for Biotechnology Information , U.

Transl Lung Cancer Res. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Email: rf. Received Aug 28; Accepted Oct 7. Copyright Translational lung cancer research. All rights reserved. This article has been cited by other articles in PMC. Abstract 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.

Introduction Even after complete resection of operable non-small cell lung cancer NSCLC , patients are at high risk of recurrence 1. PORT through the prism of evidence-based medicine The PORT meta-analysis which initially included 9 randomized trials 6 - 12 is a landmark study published in 13 and updated in 14 with a 10 th study Table 1 Details and results of certain phase III studies.

Open in a separate window. Could an increase of loco-regional control be beneficial to high risk patients? Is the detrimental effect of PORT still an issue with modern radiotherapy? Figure 1. Acknowledgements Disclosure: The authors declare no conflict of interest.

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