Incorporating Surgery in treatment of Stage IIIA – N2 Non- Small Cell Lung Cancer

Binay Thakur,Mukti Devkota

doi:10.3126/njc.v5i1.41369

Abstract

Stage IIIA-N2 Non-small cell lung cancer includes heterogenous group of patients with a poor 5-year survival ranging from 13% to 36% with surgery alone. Various randomized controlled trials established the role of multimodality treatment either including or excluding surgical resection. In a select group of non-bulky/ single station N2 disease, the better results have been achieved with induction chemotherapy or chemo-radiotherapy followed by surgery.

Highlights

Lung cancer is the most common cancer diagnosed worldwide and the leading cause of cancer-related deaths.[1]
Induction by concurrent chemoradiotherapy followed by surgery resulted in 5-year survival rates of 30% to 40%, appearing superior to surgery alone. 9-11 a consensus has not been reached on which induction therapy should be administrated to stage IIIA-N2 patients - 50% of the National Comprehensive Cancer Network (NCCN) member institutions choose induction chemoradiotherapy, while another 50% choose induction chemotherapy.[12]
Incidental pN2 after surgery – adjuvant chemotherapy with or without radiation therapy (RT) Discrete nodes; single station Induction CT/ CTRT followed by nodes; less than 3 cm in size surgery In EGFR nutation positive cases, induction Erlotinib followed by surgery may be an alternative op SCTS: The Society of Cardiothoracic Surgery in Great Britain and Ireland ACCP: American College of Chest Physicians ESMO: European Society of Medical Oncology NCCN: National Comprehensive Cancer Network NICE: National Institute for Health and Care Excellence ATORG: Asian Thoracic Oncology Research Group

Summary

Introduction

The meta-analysis showed best OS results with fewer treatment-related deaths in neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy arms.[14] In clinical practice, it is important to recognise situations where the patient can be offered multiple treatment options. The aim of this study is to review existing evidences and guidelines for the role of surgery for IIIA-N2 NSCLC. “N2” is a broad terminology stating positive mediastinal nodes. It can be further divided into various subgroups depending upon the nodal burden: 1. A simpler definition would be non-bulky (single station node of diameter < 3 cm and without invasion into trachea or major vessels) and bulky nodes.[15]

IB carina

Potentially resectable

Surgery and Targeted Therapy

Surgery and Immunotherapy

Definitive CTRT Durvalumab

Induction CTRT followed by surgery

Findings

Conclusion