Current Status of Postoperative Radiation for Non–Small-Cell Lung Cancer

Radiation therapy can increase local control and potentially improve survival in patients who have had resection for lung cancer. However, radiation therapy also has the potential to cause serious toxicity and should not be indiscriminately delivered. The PORT meta-analysis clearly illustrated the potential toxic effects of postoperative radiotherapy (PORT). Modern three-dimensional radiation treatment planning facilitates the design of treatment fields that more conformally treat the site(s) at risk, and this appears, based on limited data, to improve the therapeutic ratio of PORT. Moreover, systemic and local therapies are likely synergistic, and thus improvements in systemic staging and treatment may increase the ability of local therapies to improve overall survival. Therefore, a reassessment of the utility of postoperative radiation therapy using limited fields and modern techniques is warranted.