[Postoperative radiotherapy after complete resection of stage II (N1) non-small-cell lung cancer: reasons for not proposing it].

: Postoperative external radiation in non-small-cell lung cancer has remained a topic of debate since the first randomized study examining the potential contribution of postoperative radiotherapy published more than 35 years ago and despite a recent meta-analysis published in 1998 that included 9 randomized prospective studies. Among the 4 eligible randomized studies including non-small-cell lung cancer patients in complete remission of stage II (N1) disease, none demonstrated a significant advantage on survival. In addition, some of these studies disclosed an apparently deleterious effect after postoperative radiotherpy. Although the modalities and the technical quality of radiotherapy and surgical resection were different for the different studies or within a given study, or in some of the older studies even obsolete, and although the precision of the outcome evaluation can be criticized, there is currently no argument for proposing postoperative radiotherapy as a routine systematic practice with conventional methods of bidimensional dosimetric planification after complete surgical resection with good quality mediastinal node dissection for non-small-cell lung cancer patients with stage II (N1) disease. However, the contribution of postoperative radiotherpy with sufficient means for performing tridimensional conformational radiotherapy with individual optimization of computerized dosimetric planification taking into account the residual respiratory function after surgery remains to be evaluated in randomized prospective studies with rigorous control of the technical quality of the surgical resection and the radiotherapy and a precise statistical analysis of the locoregional and distant events in case of incomplete surgical resection and in more advanced stage disease (parietal T3, N0, stage III N2).