Optimal sequencing of adjuvant chemotherapy and radiation therapy in resected non-small cell lung cancer with pathological N2 disease

An impressive clinical trial record exists in the investigation of the clinical benefits and risks related to the utilization of post-operative radiation therapy (PORT) in resected localized and locally-advanced non-small cell lung cancer (NSCLC). These trials generally demonstrated that local control can be improved with the application of PORT; however, the impact on overall survival was less certain. In response to this uncertainty, the PORT Meta-analysis Trialists Group published an individual patient meta-analysis on this important topic in 1998 (1). This report identified a statistically significant reduction in survival with the application of PORT to all nodal (N0–N2) groups. In the most recent update of the meta-analysis, PORT was associated with an 18% relative increase in the risk of death (i.e., hazard ratio: 1.18) (2).