BACKGROUND:
The management of operable locally advanced N2
non-small cell lung cancer (NSCLC) is a controversial topic. Concurrent chemoradiation (CT-RT) is considered the
standard of care for inoperable or unresectable
patients, but the
role of trimodality
treatment remains controversial. We present our institution's experience with the management of stage III (N2) NSCLC
patients, analyzing whether the addition of
surgery improves
survival when compared with definitive CT-RT alone.
METHODS:
From 1996 to 2006, 72 N2 NSCLC
patients were treated. Thirty-four
patients received
cisplatin-based
induction chemotherapy, followed by
paclitaxel-
cisplatin CT-RT, and 38
patients underwent
surgery preceded by induction and/or followed by adjuvant
therapy.
Survival curves were estimated by
Kaplan-Meier analysis, and the differences were assessed with the log-rank test.
RESULTS:
Most of the
patients (87 %) were
men. The median age was 59 years. A statistically significant
association between T3-T4c and definitive CT-RT as well as between T1-T2c and
surgery was noted (p < 0.0001). After a median follow-up period of 35 months, the median overall
survival (OS) was 42 months for the
surgery group versus 41 months for the CT-RT
patients (p = 0.590). The median
progression-free survival (PFS) was 14 months after
surgery and 25 months after CT-RT (p = 0.933). Responders to radical CT-RT had a better OS than non-responders (43 vs. 17 months, respectively, p = 0.011). No significant differences were found in the OS or PFS between the pN0 [14 (37.8 %)
patients] and non-pN0
patients at
thoracotomy. Three
treatment-related deaths (7.8 %) were observed in the surgical cohort and none in the CT-RT group.
CONCLUSIONS:
The addition of
surgery did not render a median OS or PFS benefit when compared with CT-RT alone in our series of stage III-N2 NSCLC
patients, in accordance with previously published data. However, responses to CT-RT had a greater impact in terms of OS and PFS. Although the
patients selected for management including
surgery showed a favorable T clinical staging in comparison to
patients exclusively treated with definitive CT-RT,
similar survival outcomes were found (AU)