Postoperative radiation therapy in lung cancer: A controlled trial after resection of curative design

Houtte, Paul Van; Rocmans, Pierre Arthur; Smets, Philippe; Goffin, J.; Lustman-Marechal, J; Vanderhoeft, Patric; Henry, Jane

doi:10.1016/0360-3016(80)90105-4

Cited by 211 publications

(51 citation statements)

References 14 publications

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“…[25][26][27][28][29][30][31][32] Furthemore, a nonrandomized study of patients with resected N2 cancer 35 indicates a survival advantage for the group of 88 patients who received postoperative radiotherapy. Ten randomized trials [5][6][7][8][9][10][11][12][13][14][15] involving a total of 1711 evaluable patients failed to demonstrate an improve- 11 Lung Cancer Study Group, 10 and the Van Houtte trial 9 ) used doses of 40 Gy, 50 Gy, and 60 Gy, respectively. The total dose used in the current trial (60 Gy) was calculated at the central axis, at the midplane depth, or at the intersection point of multiple fields, as recommended by the International Commission of Radiation Units.…”

Section: Discussionmentioning

confidence: 99%

“…34 In our study, the dose per fraction ranged between 2 and 2.5 Gy. The Lung Cancer Study Group, 10 Van Houtte, 9 and British Medical Research Council 11 trials used doses per fraction of 1.8 -2 Gy, 2 Gy, and 2.67 Gy, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…However, the efficacy and safety of this treatment are uncertain. Ten randomized trials [5][6][7][8][9][10][11][12][13][14][15] have assessed the effect of postoperative radiotherapy at doses ranging from 40 to 60 gray (Gy), but some trials were conducted many years ago, when technics and radiotherapy equipment were different from today, and included fewer than 100 patients per treatment arm. A nonsignificant trend toward a reduction in local recurrences was reported in some of them, but no clear trend toward a survival benefit was found.…”

mentioning

confidence: 99%

“…A nonsignificant trend toward a reduction in local recurrences was reported in some of them, but no clear trend toward a survival benefit was found. Moreover, one trial 9 showed a nonsignificant trend toward a detrimental effect in patients with Stage I disease. Given the discrepancy between results of clinical trials and current practice, irrespective of the lymph node status, we conducted a randomized comparative trial to evaluate the impact of adjuvant radiotherapy.…”

mentioning

confidence: 99%

See 3 more Smart Citations

A controlled study of postoperative radiotherapy for patients with completely resected nonsmall cell lung carcinoma

Dautzenberg

Arriagada

Chammard

et al. 1999

Cancer

233

110

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

A controlled study of postoperative radiotherapy for patients with completely resected nonsmall cell lung carcinoma

Dautzenberg

Arriagada

Chammard

et al. 1999

Cancer

233

110

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“…In an analysis involving 175 of 224 randomised patients with tumour confined to the lung, that is, with no intraoperative evidence of lymph node metastases (Van Houtte et al, 1980), survival was better in the non-irradiated group, the 5-year survival rate being 43% in this group compared with 24% in the irradiated group. Although the survival difference was not statistically significant, the size of the effect observed raised the question whether post-operative mediastinal radiotherapy might be harmful in patients with NO or NI disease.…”

mentioning

confidence: 98%

The role of post-operative radiotherapy in non-small-cell lung cancer: a multicentre randomised trial in patients with pathologically staged T1-2, N1-2, M0 disease

Stephens

Girling²,

Bleehen³

et al. 1996

Br J Cancer

173

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Summary The role of post-operative radiotherapy for patients with non-small-cell lung cancer (NSCLC) is unclear despite five previous randomised trials. One deficiency with these trials was that they did not include adequate TNM staging, and so the present randomised trial was designed to compare surgery alone (S) with surgery plus post-operative radiotherapy (SR) in patients with pathologically staged TI-2, NI-2, MO NSCLC. Between July 1986 and October 1993, 308 patients (154 S, 154 SR) were entered from 16 centres in the UK. The median age of the patients was 62 years, 74% were male, >85% had normal or near normal levels of general condition, activity and breathlessness, 68% had squamous carcinoma, 52% had had a pneumonectomy, 63% had NI disease and 37% N2 disease. SR patients received 40 Gy in 15 fractions starting 4-6 weeks post-operatively. Overall there was no advantage to either group in terms of survival, although definite local recurrence and bony metastases appeared less frequently and later in the SR group. In a subgroup analysis, in the NI group no differences between the treatment groups were seen, but in the N2 group SR patients appeared to gain a one month survival advantage, delayed time to local recurrence and time to appearance of the bone metastases. There is, therefore, no clear indication for post-operative radiotherapy in Nl disease, but the question remains unresolved in N2 disease.Keywords: non-small-cell lung cancer; randomised trial; post-operative radiotherapy For patients with potentially resectable, non-small-cell lung cancer (NSCLC) without distant metastases, the standard treatment is an intended curative resection. In 1986, at the time this trial was planned and activated, a number of studies had already clarified some of the factors affecting resectability and subsequent prognosis.Firstly, it was already clear that the duration of subsequent survival was greatly reduced if the mediastinal nodes were found to be involved. For example, in a consecutive series of 245 patients undergoing curative resection, Wilkins et al. (1978) reported 5-year survival rates of 42% in patients without mediastinal node involvement compared with only 16% with such involvement. Greschuchna and Maassen (1980) reported corresponding rates of 37% and 11%, and broadly similar results were reported by others (Edwards, 1979;Mountain, 1986).Secondly, the importance of careful preoperative staging in the selection of patients suitable for intended resection was appreciated, particularly the need to avoid inappropriate thoracotomy in patients with T3 tumours, gross mediastinal node involvement or metastatic disease (Pearson, 1980;Spiro and Goldstraw, 1984). This need can only be met if, in patients otherwise suitable for thoracotomy, the mediastinum is staged, using such techniques as computerised tomography (CT), cervical mediastinoscopy and anterior mediastinotomy (if so indicated for left upper lobe tumours), and if clinical

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Primary Lung Cancer Surgery in Stage II and Stage III

Neptune

1988

Arch Surg

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Postoperative radiation therapy in lung cancer: A controlled trial after resection of curative design

Cited by 211 publications

References 14 publications

A controlled study of postoperative radiotherapy for patients with completely resected nonsmall cell lung carcinoma

A controlled study of postoperative radiotherapy for patients with completely resected nonsmall cell lung carcinoma

The role of post-operative radiotherapy in non-small-cell lung cancer: a multicentre randomised trial in patients with pathologically staged T1-2, N1-2, M0 disease

Primary Lung Cancer Surgery in Stage II and Stage III

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