For patients with resectable tumor, the cure rate by surgery alone is in the range of 40 to 50%, and the majority of failures are due to presumably a combination of locoregional and distant metastases. Because of the rareness of these tumors, data on the pattern of failure after surgery are very sparse.
The ultimate goal of postoperative radiation therapy is to improve the probability of cure for patients with a high risk for local and regional failure. However, postoperative radiation therapy is a local and regional treatment, and its benefit may not result in a gain in survival should there be preexisting distant metastases. Patients with a positive margin for residual cancer have a high risk for local recurrence and subsequent failure.
When we compared the outcome of therapy in patients who received postoperative radiotherapy for either positive resection margins for residual cancer or close margins of 0.2 cm or less with those who had clear margins and did not receive postoperative radiation therapy, the median survival time was 136 months
figure 41-3 A sagittal view of the thorax with a composite isodose plan of three-dimensional conformai radiotherapy. The planning target volume (PTV) is covered with 95% of the isodose line.
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