In this study, researchers have proved that Lung cancer is the leading cause of cancer death in the United States, comprising almost one-quarter of the estimated cancer deaths in men and women.

Over 80% of lung cancer cases are non–small-cell lung cancer (NSCLC), with the vast majority being locally advanced. For patients who undergo resection, there is a plethora of level 1 evidence that supports the use of adjuvant chemotherapy, with improvement in both overall survival (OS) and disease-free survival. However, the role of postoperative radiation therapy (PORT) remains controversial as studies demonstrate conflicting results regarding improvement in OS and locoregional control.


The study included 8631 patients, 4579 of whom received surgery alone and 4052 of whom underwent PORT. There was no difference in overall survival (OS) after PS matching and IPTW (hazard ratio [HR], 0.99; P =.76). PORT, on the other hand, increased OS in a subset of patients with an LN positive to the sampled ratio of less than equal to 50% (HR, 0.90; P =.01). Furthermore, even with chemotherapy, there was a trend toward improved OS in this subset (HR, 0.91; P =.09).

For all patients with pN2 NSCLC, PORT is not related to an improvement or a decrease in OS. Patients with a positive to sampling LN ratio of less than equal to 50%, independent of treatment status, may benefit. PORT will remain the standard of care while the findings of the ongoing LUNG ART study are awaited.

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