Abstract
The effectiveness of postoperative radiotherapy (RT) was retrospectively studied in 71 cases of pT3-4 and/or n2-3 NSCLC. We scheduled 50 Gy RT with a portal including the hilum and the upper madiastinum, although some modifications were made in specific cases. RT was performed in 39 cases including 27 curative resection cases, among which a dose of more than 39 Gy was delivered in 30 cases.
A total of 37.9% of 34 curative resection cases in stage IIIA and 11.8% of 17 curative cases in stage IIIB survived for three years after the operation, while none (0%) of 13 patients with macroscopic residual tumors survived for three years. Seven cases of intrapulmonary metastasis were excluded from analysis. Analysis of pT4 and/or n2-3 cases which achieved survival for more than 6 months after the curative resection revealed that the 3-year survival rates in 19 RT cases (>39 Gy) and 15 non-RT cases were 45.6% and 9.8%. The local recurrence rates were 21.1% and 60.0%, while the distant metastasis rates were 36.8% and 53.3%. Local recurrence in the RT group was observed at the supraclavicular fossae which was out of the radiation portal, and metastatic mediastinal lymph nodes were found at two or more sites.
The desired dose could not be delivered in the majority of the cases with macroscopic residual tumors. In some cases RT was not undertaken due to the poor post-operative condition of the patients.
In conclusion, RT was effective in eradicating local subclinical disease and also in improving the survival rate. Our findings on local recurrence demonstrated that the supraclavicular fossae should also be included in the radiation portal in the cases with two or more metastasized mediastinal lymph node sites for better local control.
