Evidence Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Oct 24, 2021; 12(10): 833-844
Published online Oct 24, 2021. doi: 10.5306/wjco.v12.i10.833
Postoperative radiotherapy in resected non-small cell lung cancer: The never-ending story
Javier Serrano, Patricia Calvo Crespo, Begoña Taboada, Ana Alvarez Gonzalez, Rafael Garcia García, Antonio Gomez Caamaño, Juan Carlos Trujillo Reyes, Xabier Mielgo-Rubio, Felipe Couñago
Javier Serrano, Department of Radiation Therapy, Clinica Universidad de Navarra, Madrid 28027, Spain
Patricia Calvo Crespo, Begoña Taboada, Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
Ana Alvarez Gonzalez, Department of Radiation Oncology, HGU Gregorio Marañón, Madrid 28007, Spain
Rafael Garcia García, Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
Antonio Gomez Caamaño, Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, A Coruña 15706, Spain
Juan Carlos Trujillo Reyes, Department of Thoracic Surgery, Hospital de La Santa Creu I Sant Pau, Barcelona 08026, Spain
Xabier Mielgo-Rubio, Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28223, Spain
Author contributions: All authors have contributed equally; all authors have read and approved the final manuscript.
Conflict-of-interest statement: None of the authors have any conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Javier Serrano, PhD, Consultant Physician-Scientist, Department of Radiation Therapy, Clinica Universidad de Navarra, Calle Marquesado de Santa Marta 1., Madrid 28027, Spain. fserranoa@unav.es
Received: April 15, 2021
Peer-review started: April 15, 2021
First decision: June 7, 2021
Revised: June 20, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: October 24, 2021

This manuscript collects in a joint and orderly manner the existing evidence at the present time about postoperative treatment with radiotherapy in non-small cell lung cancer. It also systematically reviews the current evidence, the international recommendations in the most relevant guidelines, the most controversial aspects in clinical and pathological staging, the specific technical aspects of radiotherapy treatment, and also collects all the potential risk factors that have been postulated as significant in the prognosis of these patients, evaluating the possibility of segmenting a particularly sensitive subpopulation with a high risk of relapse on which an adjuvant treatment with radiotherapy could have an impact on their clinical evolution. Finally, currently active trials that aspire to provide more evidence on this topic are reviewed.

Keywords: Non-small lung cancer, Radiotherapy, Postoperative, Lung cancer

Core Tip: The approach to the postoperative treatment of non-small cell lung cancer (NSCLC) is one of the pending subjects of the specialty of Radiation Oncology. Despite the enormous anticipation that the Lung-Art trial had produced, its results leave issues unresolved. In this article, we attempt to systematically recapitulate the currently existing evidence for the radiotherapeutic management of this pathology, in order to identify those patients who could potentially benefit more from postoperative treatment in NSCLC.