Adjuvant radiotherapy after curative resection in non-small cell lung cancer (NSCLC) - The case against

Local failure remains a significant problem in the era of adjuvant chemotherapy for completely resected NSCLC, reaching 25% in two recent studies, suggesting a role for adjuvant radiotherapy. However, a recently updated meta-analysis of 9 trials including 2128 patients showed a 21% relative increase in risk of death after post-operative radiotherapy. This risk was limited to patients with N0-1 disease. While this does not exclude a role for radiotherapy in N2 disease, one large recent trial of adjuvant chemotherapy raised the possibility that drug-radiation interactions might also increase mortality. Most previous trials have used wide-field radiotherapy, and have not used modern planning or treatment techniques. Although the current evidence does not support the use of adjuvant radiotherapy, new trials are needed to test radiotherapy delivered to small volumes at high risk of local relapse in patients with N2-3 disease using conformal radiotherapy and newer delivery techniques.