O LUNG, where ART thou?

Adjuvant radiation for lung cancer: when do you use it? Most people say after (C→RT) or with (CRT) chemotherapy for resected N2 disease or positive margins. Unfortunately, we have limited data to guide us on whether the sequential or concurrent approach is best--since lung cancer is such a rare disease, cough cough. A new NCDB analysis takes an interesting look at this question among patients with either negative-margin pN2 disease and or any positive margins. Notably, patterns of care significantly changed from 2006 to 2012. For pN2 disease, use of the C→RT approach increased from 53% to 63%, while, for positive margins, CRT use increased from 67% to 81%. The most important finding, though, was that C→RT was associated with improved survival when compared to CRT for pN2 disease (58 vs 40 months, respectively). Outcomes were worse overall for those with positive margins, though there was a likewise trend towards improved survival favoring C→RT (43 vs 39 months). Where does this leave us? Waiting for the results of LUNG ART. In the meantime, it may be smart to stick with sequential chemo then radiation, particularly when there is a strong indication for adjuvant chemotherapy.