The optimal sequencing of postoperative chemotherapy and radiation therapy in patients with locally advanced or incompletely resected non-small cell lung cancer

The National Comprehensive Cancer Network (NCCN) provide specific, evidence based guidelines for the treatment of non-small cell lung cancer (NSCLC) of any stage at presentation (1). Those patients who are suspected or proven to have N2 lymph node involvement are suggested to have either neoadjuvant chemotherapy with or without radiation therapy followed by surgery, or definitive chemoradiation therapy alone. Those patients who are suspected of having disease that will result in R1 or R2 resections (unresectable) are suggested to have combined chemoradiotherapy (1). These guidelines would imply that if discussions of adjuvant treatment of N2 disease are underway that the N2 disease was found incidentally after surgery and not found by preoperative mediastinal staging methods. Similarly, R1–2 resections are not usually a planned or desired result after a surgical attempt at cure of NSCLC. It is helpful to put these two distinct clinical entities in perspective of incidence and survival impact