How do you approach adjuvant therapy for resected lung adenocarcinoma that was found unexpectedly postop to be N2?

Preliminary results of the phase 3 randomized LungART trial (NCT00410683) were recently presented at a virtual ESMO conference. 501 patients with pathologically confirmed N2 NSCLC s/p complete resection were randomized to postoperative RT (54 Gy) or observation. Almost all patients received chemothe...

I review the LungART abstract and controversy around this with patients now and discuss the pros and cons of treatment, but at this point, we still tend to offer post operative radiation at our institution. I think there are a few important things to keep in mind with the LungART trial when these ca...

Based on the two published randomized studies regarding PORT in N2 positive NSCLC (Hui et al., PMID 34165501 and Le Pechoux et al., PMID 34919827), I would not offer PORT for patients who had adequate LN dissection and were found to have single station positive mediastinal LN.

However, I would consid...

On September 27, 1996, a prominent surgical oncologist did what he could to enlighten the masses that the treatment of lymph nodes cannot bend a patient's survival curve. He highlighted that despite the preponderance of evidence that demonstrates this, clinicians around the world continue to believe...

It’s time to stop offering PORT (again).

- The RCTs from the past and meta-analysis showed that RT was not improving survival despite reducing LR. In fact, it was possibly hurting patients. PORT was no longer recommended.

- Then with the advent of beneficial adjuvant chemotherapy, with a re-analysis...

Local failure after resection of stage III lung cancer is not acceptable in my opinion. PORT is always offered for improved local control, not for overall survival. These are the consistent findings in every single trial that has looked at this, and this observation includes the results of Lung ART ...

Adjuvant chemotherapy would be standard. We look at which nodes were involved and which were sampled while deciding on adjuvant radiation. If the highest sampled node station had positive nodes, or multiple stations were involved, we would offer adjuvant radiation following chemotherapy.

I have historically treated most pN2 patients with PORT mostly because of the exploratory subgroup analysis from the PORT meta-analysis and post-hoc analysis from the ANITA trial but have always had concerns given the lack of higher level prospective data. I am now strongly reconsidering given the p...

I would not recommend adjuvant XRT for patients with N2 disease post resection. The Lung ART data recently published clearly demonstrates no improvement in survival with PORT including in patients with unforseen N2 disease. The potential increased toxicity with postop XRT further deters me from rout...