Adjuvante Mediastinalbestrahlung bei nichtkleinzelligem Lungenkarzinom (pN2)

Background: Patients with non-small-cell lung cancer (NSCLC) have a high risk for developing mediastinal relapse. Although adjuvant chemotherapy is the standard of care in locally advanced disease, the role of postoperative radiotherapy (PORT) has not been clearly defined. Over the past 50 years, several prospective, randomized trials and meta-analyses have been conducted addressing this question. While patients without mediastinal lymph node involvement do not benefit from PORT, meta-analyses have suggested that patients with pN2 disease could benefit from PORT. Recently two prospective phase III randomized trials (LungART and PORT-C) were conducted testing PORT vs. no PORT in patients with stage IIIA/pN2 disease. There was no significant difference in disease-free (DFS) or overall survival between the two groups but there was a significant difference in the risk of mediastinal relapse in both studies. In the PORT C study, there was a statistically significant improvement in DFS and local recurrence-free survival at 3 years in the “per protocol” analysis. Selected patients with risk factors, such as extracapsular extension, R1 resection, or with a high mediastinal burden might benefit from PORT. Conclusion: PORT does not lead to survival benefit in unselected patients with stage IIIA/pN2 NSCLC after complete resection without extracapsular lymph node extension. Selected patients with risk factors, such as extracapsular extension, R1 resection or with a high mediastinal burden, could benefit from PORT by significantly reducing the risk of mediastinal relapse.