Reply to Durand

Abstract

of disease aggressiveness regarding microvascular invasion [4] and gene mutations [5] despite the stage. The trend is to find evidence of benefit from adjuvant therapy to epidermal growth factor-muted patients, even for early stage of lung cancer (e.g., the Randomized, Double-Blind Trial in Adjuvant NSCLC with Tarceva (RADIANT) trial, double-blind randomized of erlotinib in the adjuvant setting of I–IIIa NSCLC). Moreover, the authors have accurately stated that extended lymphadenectomy is not more morbid than sampling. As a conclusion, regarding the benefit/risk expected of extended lymphadenectomy and the absence of accuracy of PET/CT for small-size structures, I was expecting the authors to conclude that PET/CT is not relevant for small-size tumor or node metabolic evaluation. A trial evaluating the omission of extended lymphadenectomy in small-size tumors with no lymph node uptake on PET–CT appears unethical and obviously exposes the arm of patient without lymphadenectomy to a loss of chance (risk of under staging and under treatment). In addition, a ‘wait-for–grow-’ attitude for non-uptaking nodes with suspect morphologic characteristics is a misbenefit of technology. REFERENCES