What is the role of radiotherapy after surgery in the treatment of operable stage II NSCLC?
Radiotherapy either to the tumour bed or to the regional lymph nodes may be employed after surgery to reduce local recurrence, and possibly improve survival. The role of external beam radiotherapy following complete resection of NSCLC has been extensively investigated, but there is less information on the role of radiotherapy following incomplete removal of the tumour.
Postoperative external beam radiotherapy (PORT) versus no radiotherapy
There is strong evidence, based on an individual patient data meta-analysis and recently updated, that the use of postoperative radiotherapy following complete resection of stage II NSCLC is detrimental, and is associated with worse survival. 
In 718 patients with stage II disease randomised to PORT or no PORT, there was an increased risk of death with a hazard ratio was 1.24 (95% C.I.: 1.04, 1.52) in patients randomised to PORT.
Evidence summary and recommendations
|Following complete resection of stage II NSCLC, the addition of adjuvant external beam radiotherapy decreases survival||I|||
|In patients who have had complete resection of stage II NSCLC, postoperative radiotherapy is not recommended.||A|
- PORT Meta-analysis Trialists Group. Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev 2005 Apr 18;(2):CD002142 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15846628].