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Postoperative radiation therapy (PORT) in the combined treatment of non-small cell lung cancer (NSCLC) can improve the locoregional control of the disease regardless of the prevalence of tumor and improve the survival rates for the IIA-IIIB stage NSCLC compared with the surgical method alone. For more accurate assessment of the role of PORT the comparative analysis of the relapses structure after combined modality and surgical treatment of NSCLC was carried out.

Conducting postoperative radiotherapy in a mode of hypofranctionation with SFD-3Gy to TFD-36-39Gy (EQD2 = 43,246,8Gy) in combined treatment of patients with non-small cell lung cancer allows significantly increasing a 5-year disease-free survival at IIB-IIIB stages of the disease (pN1-2) as well as the central cancer, squamous cell morphological type of tumor after surgery in a volume of lob-bilobectomy. The clearest effect of postoperative radiotherapy is assessed by survival without locoregional recurrence where radiation therapy in the adjuvant setting allows achieving a statistically significant increase in local control of the disease to the level of 85-95% regardless of stage of the disease, tumor size, regional lymph nodes lesion and the surgical treatment.

The review considers the history of evolution and the present state of the problem of postoperative radiotherapy for non-small cell lung cancer. The randomized trials and meta-analyses given in recent publications provide evidence that it should be used in radically operated patients with morphologically verified regional metastases. The paper also shows promises of hypofractionation and a postoperative radiation/chemotherapy ratio for non-small cell lung cancer.

Compared with surgical treatment the combined treatment of patients with non-small cell lung cancer accompanied by post-operative radiotherapy in the mode of hypofractionation from 3 Gy to SOD-36-39 Gy (EQD2 = 43,2-46,8 Gy) allowed statistically significant increasing a 5- and 10-year overall and disease-specific survival in patients with metastases to regional lymph nodes (pN1-2). The increase of overall and disease-specific survival was also observed in patients older than 60 years with the worst initial status (70-80 by the Karnofsky scale), II stage of disease, peripheral cancer and adenocarcinoma however for these groups survival differences did not reach a statistically significant level. The presented method of postoperative irradiation did not have severe toxicity and did not lead to a decrease in survival of elderly and functionally debilitated patients.

Background We aimed to evaluate the effect of hypofractionated post-operative radiotherapy on overall survival, disease-free survival (DFS), and local control rate in completely resected stage IA–IIIB non-small-cell lung cancer (NSCLC); to estimate radiation-induced toxicity. Methods We retrospectively investigated 306 (266 male, 40 female) patients with stage IA–IIIB NSCLC who underwent complete resection of the lung tumour followed by post-operative radiotherapy in our institution from 1995 through 2012. Patients underwent pneumonectomy (34%), lobectomy (5%), bilobectomy (55%), or segmentectomy (6%). The post-operative pathological stages were I (41%), II (32%), and III (27%). Histology concluded adenocarcinoma (26%), squamous cell carcinoma (59%) or other (15%) pathologies. Following surgery, 149 patients received post-operative radiotherapy of 36 Gy in 12 daily fractions of 3 Gy (group 1), and 157 patients received post-operative radiotherapy of 44 Gy in 22 daily fractions of 2 Gy (group 2). Median follow-up was 25 months. Radiotherapy toxicity was scored in accordance to RTOG scale. Findings In group 1 and group 2, respectively, 5-year overall survival was 49.5 ± 5.2% and 45.6 ± 4.3%, 5-year DFS was 54.1 ± 5.1% and 52.1 ± 4.1%, and 5-year local control rate was 88.0 ± 4.5% and 87.0 ± 4.5%. Grade 1 oesophagitis was observed in 82.8% patients (group 1 79.8%; group 2 86.0%), grade 2 in 15% patients (group 1 17.8%; group 2 12.1%), and grade 3 in 2.2% patients (group 1 2.4%; group 2 1.9%). No late oesophageal toxicity was observed in either group. Grade 1 subclinical radiotherapy-induced pneumonitis was detected in about 67% of patients. Symptomatic radiation pneumonitis (grade ⩾ 2) was not detected in either group. Interpretation Hypofractionated post-operative radiotherapy achieved local disease control in 88% of patients with NSCLC without increasing treatment-related toxicity compared with a conventional irradiation regimen. Decreasing the number of fractions and length of the treatment allows radiation apparatuses to be occupied 30% less, and in turn allows more patients to be treated.