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David S. Ettinger, MD, FACP, FCCP


Lung ART Trial: Postoperative Radiotherapy Under Study in Stage IIIAN2 NSCLC

By: Victoria Kuhr, BA
Posted: Wednesday, February 16, 2022

Postoperative radiotherapy in patients with stage IIIAN2 non–small-cell lung cancer (NSCLC) does not appear to be associated with an increased disease-free survival compared with no postoperative radiotherapy. Cecile Le Pechoux, MD, of the International Center for Thoracic Cancers, Villejuif, France, and colleagues shared their findings from the phase III Lung ART trial in The Lancet Oncology.

“Lung ART provides robust evidence that 3D conformal postoperative therapy cannot generally be recommend as part of the standard of care in patients with resected stage IIIAN2 non–small cell lung cancer, as more toxicities were observed in the postoperative therapy compared to the control group,” said the authors.

The study recruited patients from August 7, 2007, to July 17, 2018, from 64 hospitals and cancer centers in France, the United Kingdom, Germany, Switzerland, and Belgium. The study included patients with stage III NSCLC with complete resection, nodal exploration, and cytologically or historically proven N2 involvement. Patients received postoperative radiotherapy doses of 54 Gy in 27 or 30 daily fractions, on 5 consecutive days a week. The study measured disease-free survival and intention to treat at 3 years.

Of the 501 patients enrolled in the study, 252 received postoperative radiotherapy group and 249 did not. The median follow-up was 4.8 years. The 3-year disease-free survival rate was 47% with postoperative radiotherapy and 44% without postoperative therapy. The median disease-free survival rate was 30.5 months in the postoperative therapy group and 22.8 months in the control group.

The most common grade 3 or 4 adverse events were pneumonitis, lymphopenia, and fatigue. Late grade 3 or 4 cardiopulmonary toxicity was reported in 11% patients given postoperative radiotherapy compared with 5% who were not.

Disclosure: For full disclosures of the study authors, visit

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