After complete resection of Stage I non-small cell lung cancer (NSCLC), the role of adjuvant therapy is best summarized thus as:

E. Adjuvant therapy is not indicated after complete resection of Stage I NSCLC.

DISCUSSION: Prospective randomized trials conducted by the Lung Cancer Study Group demonstrate that postoperative chemotherapy may be responsible for significantly longer disease-free survival in patients with Stage III (and perhaps Stage II) NSCLC. The efficacy of postoperative chemotherapy and radiotherapy in patients with extensive lymph node involvement or positive surgical margins in reducing systemic recurrences and prolonging disease-free survival has also been demonstrated. Adjuvant therapy is not associated with improved overall survival and has not been shown to be beneficial in patients with Stage I NSCLC.

Radiation therapy is an effective adjuvant treatment in many patients with carcinoma of the lung. Adjuvant radiotherapy, applied to patients with completely resected Stage II or Stage III (but not Stage I) NSCLC, has been shown to decrease local recurrence but has no significant effect on survival. However, postoperative irradiation may provide a survival advantage in patients who have resection and are found to have metastases to hilar or mediastinal lymph nodes. Thus, the purpose of adjuvant radiotherapy is prevention of local tumor recurrence, especially when lymph node sampling of the mediastinum at thoracotomy is incomplete.