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April 25, 1966

Does Postoperative Irradiation Improve Survival in Lung Cancer?

JAMA. 1966;196(4):345-347. doi:10.1001/jama.1966.03100170087028

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The treatment of carcinoma of the lung is unrewarding, because the majority of cases, when first seen, are too advanced for anything more than palliative treatment to be possible. An overall fiveyear cure rate of the order of 3% is realistic, and surgery, which holds undisputed priority as the treatment of choice for the apparently "early" case, fails to cure once the disease has spread beyond surgically removable tissues. Most surgeons remove obvious mediastinal glands, and some attempt a routine "radical" mediastinal dissection, but a true block-dissection, as done for cervical nodes, is impossible for anatomical reasons, and once mediastinal nodes are involved, survival rates drop sharply.

It is reasonable to suggest, therefore, that postoperative radiation to the mediastinum may help to improve survival rates by dealing with local cancer which is inaccessible to the knife.

Theorizing about this, however, does not invite optimism. First, it is well-known that a

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