Postoperative irradiation in non-small cell lung cancer.

Adjuvant radiotherapy following radical surgery in NSCLC has long been a matter of debate. The pros and cons have all been discussed thoroughly and the data existing due to their partial outdated nature in respect of the diagnostic and therapeutic maneuvers used make it difficult to rely on them. Based on the existing level of evidence from randomized studies, the decision to irradiate a NSCLC patient postoperatively does not seem to be prudent, as several meta-analyses in fact have rather shown a detrimental effect than any benefit. As the majority of the randomized trials that are the bases of the meta-analyses are neither of good quality nor include those patients that are nowadays regarded as those for whom adjuvant irradiation should be discussed, other sources of information are of relevance. Subanalyses of randomized phase III trials and recently published SEER data are indicative that there is a benefit from adjuvant irradiation not only in terms of freedom from local failure but of overall survival as well. Notably, this is not at the expense of unacceptably high rates of long-term side effects.

Recurrent rectal cancer within the pelvis. A multicenter analysis of 123 patients and recommendations for adjuvant radiotherapy.

BACKGROUND AND PURPOSE: Recommendations for radiation ports in adjuvant radiation therapy for rectal cancer are mainly based on analysis of recurrence patterns. To evaluate whether changes in surgical technique have influenced this pattern of recurrence, a multicenter retrospective analysis was carried out on a patient population treated recently. PATIENTS AND METHODS: 123 patients were evaluated with the help of a CT-based self-developed 3-D data file system and an extensive questionnaire. Major inclusion criteria (one sufficient) for eligibility were: histological confirmation, clear bone destruction, and a positive PET scan, or at least three minor criteria: progressive soft tissue mass, invasion of adjacent organs on follow-up CT or MRI, rising tumor markers, and typical appearance in cross-sectional imaging. Clinical or serologic signs of inflammation were exclusion criteria. RESULTS: Initially, 54% of the evaluated patients were N0; in the remainder, N1 and N2 were distributed evenly. Initial T-category was T1 in 2%, T2 in 24%, T3 in 60%, and T4 in 13%, the male-to-female ratio was 2:1. Recurrent tumors were mainly situated in the posterior part of the bony pelvis as displayed in the figures. When abdominoperineal resection was compared to low anterior resection as primary operation, there was a significant difference in extension of recurrent tumors in the inferior parts of the pelvis (p<0.025 in all statistical tests applied), whereas no significant difference was found in the superior parts of the pelvis. CONCLUSION: Based on these results, a modest field size reduction in adjuvant radiotherapy for rectal cancer seems feasible, offering the perspective of a reduction in acute and late side effects.