Abstract
The treatment of patients with stage IIIA (N2) non-small cell lung cancer (NSCLC) is one of the most challenging and controversial areas of thoracic oncology. This heterogeneous group is characterized by varying tumor size and location, the potential for involvement of surrounding structures, and ipsilateral mediastinal lymph node spread. Neoadjuvant chemotherapy, administered prior to definitive local therapy, has been found to improve survival in patients with stage IIIA (N2) NSCLC. Concurrent chemoradiation has also been evaluated in phase III studies in efforts to improve control of locoregional disease. In certain instances, a tri-modality approach involving concurrent chemoradiation followed by surgery, may offer patients the best chance for cure. In this article, we provide an overview of the trials evaluating neoadjuvant therapy in patients with stage IIIA (N2) NSCLC that have resulted in current practice strategies, and we highlight the areas of uncertainty in the management of this challenging disease. We also review the current ongoing research and future directions in the management of stage IIIA (N2) NSCLC.
Highlights
An estimated 222,500 new cases of lung cancer are expected in the United States in 2017, of which approximately 80% will be non-small cell lung cancer (NSCLC) [1]
(N2) NSCLC treated with neoadjuvant chemotherapy followed by resection, Table 1 [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27]
IIIA NSCLC from seven randomized and retrospective studies comparing neoadjuvant chemotherapy to neoadjuvant concurrent chemoradiation found no survival benefit with the addition of radiation (HR 0.93, 95% CI: 0.54–1.62, p = 0.81) [56]
Summary
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States, 2 Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research Education Clinical. HSR&D Center, Nashville, TN, United States, 3 Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States, 4 Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, United States. DeCamp, Feinberg School of Medicine, Northwestern University, Monaliben Patel,. Specialty section: This article was submitted to Radiation Oncology, a section of the journal
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