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    Current Status of Postoperative Radiation for Non-Small-Cell Lung Cancer
    (W B Saunders Co-Elsevier Inc, 2010) Saynak, Mert; Higginson, Daniel S.; Morris, David E.; Marks, Lawrence B.
    Radiation therapy can increase local control and potentially improve survival in patients who have had resection for lung cancer. However, radiation therapy also has the potential to cause serious toxicity and should not be indiscriminately delivered. The PORT meta-analysis clearly illustrated the potential toxic effects of postoperative radiotherapy (PORT). Modern three-dimensional radiation treatment planning facilitates the design of treatment fields that more conformally treat the site(s) at risk, and this appears, based on limited data, to improve the therapeutic ratio of PORT. Moreover, systemic and local therapies are likely synergistic, and thus improvements in systemic staging and treatment may increase the ability of local therapies to improve overall survival. Therefore, a reassessment of the utility of postoperative radiation therapy using limited fields and modern techniques is warranted. Semin Radiat Oncol 20:192-200 (C) 2010 Elsevier Inc. All rights reserved.
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    Non-Small Cell Lung Cancer: Prognostic Importance of Positive FDG PET Findings in the Mediastinum for Patients with N0-N1 Disease at Pathologic Analysis
    (Radiological Soc North America, 2011) Xie, Liyi; Saynak, Mert; Veeramachaneni, Nirmal K.; Fried, David V.; Jagtap, Mandar R.; Chiu, Wing Keung; Higginson, Daniel S.
    Purpose: To assess the prognostic implications of mediastinal positron emission tomographic (PET) findings in patients undergoing curative resection of non-small cell lung cancer (NSCLC) who have histologically negative mediastinal lymph nodes (LNs), with the hypothesis that positive findings at PET are prognostic even in patients with negative histologic findings in the LNs. Materials and Methods: Records of patients with a preoperative PET undergoing curative surgery, without adjuvant radiation, for pathologic T1-3N0-1 NSCLC at the University of North Carolina between 2000 and 2006 were reviewed as an institutional review board-approved HIPAA-compliant retrospective study. Ninety patients were evaluable (all histologically negative in mediastinum; 44 with both mediastinoscopy and surgery); 13 patients had positive mediastinal PET findings, and 77 had negative mediastinal PET findings. Local-regional and distant failure rates in patients with and those without mediastinal abnormalities at preoperative PET were compared by using logistic regression and log-rank tests. Results: Median follow-up was 54.3 months (range, 1-99 months). There were higher rates of local-regional (P = .001) and distant (P,.001) failure as well as death (P = .001) in patients with postive PET findings than in patients with negative findings. In multivariable analysis (adjusting for other prognostic factors), positive PET findings in the mediastinum remained prognostic for distant failure (P,.001, hazard ratio = 6.9) and were marginally prognostic for local-regional failure (P = .093, hazard ratio = 1.9). Conclusion: Positive findings at preoperative PET in the mediastinum appear to have prognostic implications despite the mediastinal LNs being histologically negative. The high rate of local-regional and distant failure suggests that postoperative radiation therapy and/or chemotherapy may be particularly helpful in patients with positive mediastinal findings at preoperative PET.