Adjuvant Therapy for Non–Small Cell Lung Cancer with Mediastinal Nodal Involvement

The presence of ipsilateral mediastinal lymph node involvement (N2 disease) is a marker of poor prognosis in patients with resected non–small-cell lung cancer. The addition of systemic chemotherapy to the adjuvant setting has been shown to improve survival by eliminating occult micrometastatic disease. The administration of adjuvant radiotherapy for resected N2 disease is more controversial, although the data regarding outcomes rest primarily on older modalities of delivering radiotherapy. Other modalities of possibly improving survival for resected non–small-cell lung cancer with N2 disease, such as combined modality chemoradiation, prophylactic cranial irradiation, or the addition of molecularly targeted agents, remain to be proven.