The multimodal management of locally advanced N2 non-small cell lung cancer:: is there a role for surgical resection? A single institution�s experience

• Autores: Joaquim Bosch Barrera, Carlos Enrique García Franco, Francisco Guillén Grima, Marta Moreno Jiménez, José María López-Picazo González, Alfonso Gúrpide Ayarra, José Luis Pérez Gracia, José Javier Aristu Mendioroz, Wenceslao Torre Buxalleu, Jesús García-Foncillas López, Ignacio Gil-Bazo
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 14, Nº. 11, 2012, págs. 835-841
• Idioma: inglés
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• Resumen

  • 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.