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The trial that ended twenty years of argument about radiotherapy to the mediastinum after lung cancer surgery: it does not help, and it damages the heart.
Postoperative radiotherapy after resection of non-small-cell lung cancer had been contentious since a 1998 meta-analysis found it harmful in N0 and N1 disease but could not settle its effect in N2 disease. Lung ART recruited 501 patients with complete resection, nodal exploration and proven N2 involvement from 64 hospitals in France, the United Kingdom, Germany, Switzerland and Belgium, and randomised them to mediastinal radiotherapy at 54 Gy in 27 or 30 fractions or to no radiotherapy. Three-dimensional conformal planning was mandatory. Ninety-one percent were staged with FDG PET, and previous neoadjuvant or adjuvant chemotherapy was allowed.
The trial did not meet its primary endpoint: three-year disease-free survival was not significantly improved. Mediastinal recurrence fell, but late cardiopulmonary toxicity rose, and the two cancelled out.
The practical result is that postoperative radiotherapy is no longer offered routinely for N2 disease after a complete resection, and the R1 or R2 margin, not the node, is now the reason to give it. Lung ART is also an argument for modern planning: the harm signal was smaller than in the older series, but not small enough.
Shares ANITA (Adjuvant Navelbine International Trialist Association), Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Curative intent vs palliative intent, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares ANITA (Adjuvant Navelbine International Trialist Association), Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Curative intent vs palliative intent, Lung cancer (all types), IMRT / IGRT (modern external beam).
Shares ANITA (Adjuvant Navelbine International Trialist Association), Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Curative intent vs palliative intent, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Curative intent vs palliative intent, Lung cancer (all types), IMRT / IGRT (modern external beam).
Shares Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).