Abstract
Patients with clinical stage IIIA-N2 non-small cell lung cancer (NSCLC) have a 5-year overall survival (OS) of only 10%-15%, and it decreases to 2-5% in patients with mediastina N2 bulky disease. The efficacy of surgery in this stage is limited and remains controversial. In 4 different studies with a total of 1180 patients who underwent surgical resection, 5-year survival was 14-30% [1-4]. To improve this rate and supported by the introduction of new chemotherapeutic agents, induction chemotherapy (CT) has been added to the treatment approach in this stage. The theoretical advantages of induction CT include: in vivo assessment of response to CT, which would help identify patients who might benefit from adjuvant CT; early treatment of micro metastasis to increase control of distant metastases; reduction of drug resistance due to early exposure to chemotherapeutic agents and increased surgical resect ability, due to enhance of response rates that also allows preservation of healthy lung parenchyma.
Highlights
Patients with clinical stage IIIA-N2 non-small cell lung cancer (NSCLC) have a 5-year overall survival (OS) of only 10%-15%, and it decreases to 2-5% in patients with mediastina N2 bulky disease
We present 3 cases of patients diagnosed with stage IIIA non-small cell lung cancer, non-resect able at the moment of diagnosis
Neo adjuvant treatment has gained acceptance in stage IIIAN2 NSCLC because of the results of several clinical trials suggesting that it increases the OS of these patients [8,9,10,11]
Summary
Patients with clinical stage IIIA-N2 non-small cell lung cancer (NSCLC) have a 5-year overall survival (OS) of only 10%-15%, and it decreases to 2-5% in patients with mediastina N2 bulky disease. In 4 different studies with a total of 1180 patients who underwent surgical resection, 5-year survival was 14-30% [1,2,3,4] To improve this rate and supported by the introduction of new chemotherapeutic agents, induction chemotherapy (CT) has been added to the treatment approach in this stage. ALK translocation for selecting crizotinib and treatment with pemetrexed in patients with nonsquamous histology [6] They have shown a change in prognosis and an increase in survival. These new options of treatments have not been transferred to patients with stage III NSCLC, who are still receiving platinum-based doublets CT, without further treatment selection [7].
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