Stage IIIA-N2 Non-small Cell Lung Research Articles

Pneumonectomy in stage IIIA-N2 non-small cell lung cancer

Pneumonectomy in stage IIIA-N2 non-small cell lung cancer

Surgery as a Component of Multimodality Care for Known Stage IIIA-N2 Non-small Cell Lung Cancer.

Locally advanced, stage IIIA-N2 Non-small cell lung cancer (NSCLC) represents a heterogeneous patient population. Considerable controversy exists as to the optimal management of these patients. Local therapy alone with a single modality, namely surgery or radiation, is associated with high recurrence rates and low overall survival. Consequently, multimodality treatment (chemotherapy, radiotherapy, with or without the utilization of surgery) has developed as a means of both local and systemic control for patients with stage IIIA-N2 NSCLC, and has led to improved overall survival. While it is clear that multimodality therapy is beneficial, the ideal composition of the treatment regimen remains a work in progress. As a result, the optimal management of patients with stage IIIA-N2 NSCLC is widely debated, as is the role for surgery in a multimodality treatment regimen. Herein, we review the current literature supporting multimodality therapy for stage IIIA-N2 NSCLC with an emphasis on the data supporting the role of surgery in resectable and potentially resectable patients.

Adjuvant therapy in stage IIIA-N2 non-small cell lung cancer after neoadjuvant concurrent chemoradiotherapy followed by surgery.

BackgroundThis study aimed to determine whether adjuvant therapy improves survival in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC) after neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgery.MethodsWe retrospectively reviewed 467 consecutive patients with stage IIIA-N2 NSCLC who received neoadjuvant CCRT followed by surgery between 2004 and 2013. From these, we identified 398 eligible patients and their clinical outcomes were compared according to whether adjuvant therapy was provided.ResultsIn total, 296 patients (74%) received adjuvant therapy consisting of chemotherapy alone (n=71) radiotherapy alone (n=118) and both chemotherapy and radiotherapy (n=107). Adjuvant therapy was not given to remaining 102 patients. Patients who receiving adjuvant therapy were significantly younger (P=0.001), and predominantly male (P=0.014) compared to patients who did not receive adjuvant therapy. Regarding to the pathologic response, the adjuvant therapy group had a significantly poor pathologic response. However, the 5-year overall survival (OS) rate did not significantly differ between the groups (adjuvant therapy group, 52.9%; no adjuvant therapy group, 54.9%; P=0.369). After adjusting for age, sex, type of operation, cell type and yp stage, adjuvant therapy was significantly associated with better OS (hazard ratio =0.59; 95% CI, 0.38–0.92; P=0.019) and disease free survival (hazard ratio =0.62; 95% CI, 0.44–0.87; P=0.006).ConclusionsOur data indicate that adjuvant therapy is more often given to patients with poor pathologic findings. Adjuvant treatment after trimodal therapy is a significant predictor of survival after adjustment of clinical variables.

Local treatment of stage IIIA-N2 nonsmall cell lung cancer: surgery and/or radiotherapy.

Controversy exists regarding the optimal treatment of patients with stage IIIA-N2 nonsmall cell lung cancer because of its heterogeneity. Patients are at risk for both local and distant disease relapse after primary local treatment. However, there may be a window of opportunity for surgery, if mediastinal downstaging has been obtained after induction therapy. This manuscript reviews the outcome of patients treated by neo-adjuvant chemotherapy (NA-C) followed by surgery, compared with patients treated with either definitive sequential or concurrent chemoradiotherapy (cCRT), illustrated by a single-centre retrospective case series. Of 53 eligible patients, 19 received NA-C and underwent surgical resection, whilst 20 and 14 received concurrent or sequential definitive CRT, respectively. A significant difference in progression-free survival favouring NA-C followed by surgery over both CRT modalities was found. However, this translated only in an overall survival benefit in comparison with sequential definitive CRT. A trend for better outcome was observed in selected surgical patients with single-level mediastinal involvement and complete resection. Our case series results are consistent with the present standard of care of CRT, which restricts surgical resection to carefully selected patients. Immunotherapy will likely change the treatment paradigm.

Transcervical extended mediastinal lymphadenectomy for mediastinal restaging after induction therapy.

BackgroundThe aim of this study was to retrospectively evaluate long-term survival of stage IIIA-N2 non-small cell lung cancer patients operated after induction chemotherapy or chemoradiotherapy and negative mediastinal restaging with transcervical extended mediastinal lymphadenectomy (TEMLA).MethodsFrom January 2007 to December 2013, 48 stage IIIA-N2 non-small cell lung cancer (NSCLC) patients (36 men, 12 women) underwent anatomic pulmonary resection after induction therapy and negative result of mediastinal restaging with TEMLA. Mean age was 58.3 years (range, 46–75 years). There were 28 squamous cell carcinomas, 13 adenocarcinomas, 1 mixed carcinoma and 6 non-small cell lung cancers. Neoadjuvant chemotherapy was given in 24 patients, chemoradiotherapy in 23 and chemotherapy with bradytherapy in 1 patient. All patients were followed-up until death or 60 months since pulmonary resection.ResultsThere were 29 pneumonectomies, 2 lower bilobectomies and 17 lobectomies. 2 patients had R1 resection. After negative TEMLA, persistent metastatic N2 nodes were discovered in 5 patients (10.4%). The only complication after TEMLA was bilateral vocal cord paralysis observed in 1 patient (2.1%); 2 patients died in early postoperative period due to bronchial fistula (4.2%). Overall 5-year survival of patients operated after negative TEMLA was 39.5%. 5-year survival was not statistically different in patients who underwent lobectomy/bilobectomy and in patients who underwent pneumonectomy (47.4% vs. 34.5%). Five-year survival was lower in patients after chemoradiotherapy than in patients after chemotherapy alone (21.7% vs. 56.0%, P=0.022). 5-year survival was not statistically different in patients with true mediastinal downstaging and in patients with false negative TEMLA (41.9% vs. 20%, P=0.19).ConclusionsStage IIIA-N2 non-small cell lung cancer patients who underwent pulmonary resection after induction treatment and negative mediastinal restaging with TEMLA showed good long-term survival. In these patients aggressive surgery, including pneumonectomy, lead to satisfactory outcomes. However, prognosis of patients after induction chemoradiotherapy was worse.

TTF-1 Expression is Correlated with Necessity of Postoperative Radiotherapy in Stage IIIA-N2 Lung Adenocarcinoma

The role of postoperative radiotherapy (PORT) in patient with stage IIIA-N2 non-small cell lung cancer is still controversial. It is urgent to explore the prognostic factor which might be helpful to make treatment choice. Thyroid transcription factor-1 (TTF-1) is overexpressed in up to 95% of primary lung adenocarcinoma. Several studies stated that TTF-1 is a prognostic factor in NSQ-NSCLC with conflicting results by reasons of different stages and treatments. Here, we conducted this study to gain a better insight into the association between TTF-1 expression and the necessity of postoperative radiotherapy in patients with stage IIIA-N2 lung adenocarcinoma after R0 resection. Patients with pathologically confirmed inoperable stage IIIA-N2 lung adenocarcinoma and underwent R0 resection with or without PORT in our institution were eligible. Data on demographics, histology, invasion, radiotherapy, chemotherapy, and survival were collected.TTF-1 expressions were determined by immunohistochemistry using available specimen after resection. Patients were classified into the TTF-1 overexpression group (TTF-1 : 3+) and TTF-1 not overexpression group (TTF-1 score 0-2+). Overall survival(OS), progression free survival(PFS), local regional relapse free survival(LRFS) and distant metastasis free survival(DMFS) were calculated from the date of resection. The necessity of PORT is assessed by log-rank test. From October 2006 to April 2015，101 patients fulfilled the enrollment criteria. Fifty-seven patients were male and 44 patients were female. The median age was 56 years old (34-74 years old). Negative, score 1+, score 2+ and score 3+ TTF-1 expression were in 8, 8,17, 68 patients, respectively. Median follow up time was 26.8 months. In patients with TTF-1 overexpression, 19 patients received PORT and 49 did not. For these patients, none of the OS(82.9% vs.81.8%,P=0.731), PFS(57.9% vs. 51.5%P=0.518), LRFS(100% vs.97.6%P=0.513) and DMFS(63.2% VS.62.4%P=0.910) were associated with PORT .In patients without TTF-1 expression, patients who received PORT got more favorable OS (50.0% vs.20.8%P=0.137)and PFS(83.3%VS.22.0%,p=0.028) compared with who did not. Moreover, there is no significant differences in LRFS (100% VS 86.5%p=0.395) and DMFS (66.7%vs 47.1%P=0.442) between patients with and without PORT. This retrospective study demonstrates that patients with TTF-1 score 0-2+ might benefit more from postoperative radiotherapy.

Simple OS Risk Score Classification in Resected Pathological Stage IIIA-N2 Non-Small Cell Lung Cancer Patients before Postoperative Radiotherapy: A Prediction Model

Simple OS Risk Score Classification in Resected Pathological Stage IIIA-N2 Non-Small Cell Lung Cancer Patients before Postoperative Radiotherapy: A Prediction Model

The role of postoperative radiotherapy for completely resected pIIIA-N2 non-small cell lung cancer patients with different clinicopathological features: a systemic review and meta-analysis.

Background: The role of postoperative radiotherapy (PORT) in completely resected pathological stage IIIA-N2 (pIIIA-N2) non-small cell lung cancer (NSCLC) remains controversial. This meta-analysis aimed to assess the effect of PORT in patients with pIIIA-N2 NSCLC on the basis of clinicopathological features.Methods: The PubMed, PubMed Central (PMC), Embase, Web of Science, and Cochrane Library were searched for relevant studies. The main outcomes were overall survival (OS) and disease-free survival (DFS), which were compared using the hazard ratio (HR).Results: One randomized trial and 12 retrospective studies were eligible for the analysis. PORT significantly improved both OS [HR = 0.85; 95% confidence interval (CI): 0.79-0.92] and DFS (HR = 0.57; 95% CI: 0.38-0.85) compared with non-PORT treatment in patients with multiple N2 metastases or multiple N2 station involvement. No significant difference in either OS (HR = 1.03; 95% CI: 0.86-1.24) or DFS (HR = 1.08; 95% CI: 0.70-1.65) was found between PORT and non-PORT groups for patients with single N2 station involvement. No significant heterogeneity was observed. No significant differences in OS were observed between PORT and non-PORT groups for patients of different ages, sex, tumor sizes or pT stages, and histological types.Conclusions: The findings of this meta-analysis supported a role for PORT in patients with completely resected pIIIA-N2 NSCLC having multiple N2 metastases and favored withholding PORT to patients with single N2 station involvement. Further prospective randomized controlled trials are needed to confirm the findings.

Occult stage IIIA-N2 patients have excellent overall survival with initial surgery.

Patients may be found to have stage IIIA-N2 at the final pathology after the initial surgery. We want to determine the survival rate in this unique group of patients. We reviewed all patients who underwent surgical resection for lung cancer from 2000 to 2011 who had pathologic stage N2 without induction therapy. We determined the clinicopathologic characteristics and survival rate in this unique group of patients. A total of 101 patients met the inclusion criteria. The average age of the group was 65 years old with 53 (53%) females. The chest computed tomography (CT) scans showed 30 patients (30%) with mediastinal lymphadenopathy (>1 cm) and 13 (13%) with multistation disease. The positron emission tomography-computed tomography (PET-CT) showed 24 patients (24%) with N2 positive uptake. Invasive mediastinal staging prior to surgery occurred in 43 patients (43%). Eighty-four patients underwent a lobectomy (83%), 7 with bilobectomy (7%), and 10 with pneumonectomy (10%). The most common pathology was adenocarcinoma with 73 patients (72%) and the second most common was squamous cell carcinoma with 22 patients (22%). Most of the patients completed the adjuvant chemoradiation therapy (86%). The 5-year survival rate was 48% and the 10-year survival rate was 24%. Pathologic stage IIIA-N2 non-small cell lung cancer (NSCLC) is a heterogeneous disease process with a very small group of patients undergoing initial surgery. Patients with occult stage IIIA-N2 who undergo initial surgery have an excellent overall survival rate.

Prognostic factors in neoadjuvant treatment followed by surgery in stage IIIA-N2 non-small cell lung cancer: a multi-institutional study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society).

To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was performed. Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5months (5-128months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0-pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen. In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patients.

Postoperative Radiation Therapy Improves Survivals of Resected Pathological Stage IIIA–N2 Non-Small Cell Lung Cancer: A Retrospective Study of 1434 Cases from a Single Institution

Postoperative Radiation Therapy Improves Survivals of Resected Pathological Stage IIIA–N2 Non-Small Cell Lung Cancer: A Retrospective Study of 1434 Cases from a Single Institution

Postoperative Radiation Therapy Has No Effect in Improving the Survival of Patients Aged ≤55 Years with Completely Resected Pathological Stage IIIA-N2 Non-Small-Cell Lung Cancer

For patients with completely resected pathological stage IIIA–N2 non-small cell lung cancer (NSCLC), studies has shown that postoperative radiotherapy (PORT) does not improve survivals of elderly patients (＞65 years). However, the role of PORT for younger patients is not well defined. This study is to evaluate the effect of PORT on survivals as well as tumor control in patients ≤65 years. Between Jan. 2003 and Dec. 2015, patients, ≤65 years, with pIIIA–N2 NSCLC after complete resection in our single institution were retrospectively analyzed. The effect of PORT on overall survival (OS), disease free survival (DFS), loco-regional recurrence free survival (LRFS), and distant metastasis free survival (DMFS) was evaluated with Kaplan-Meier method and log-rank test. Multivariable Cox regression analysis was used to identify independent risk factors for death. Pearson chi-square test was used to compare the constituent ratios between groups. Propensity score-matched (PSM) analysis was conducted to generate comparable study arms. Statistically significant difference was set as p<0.05. Overall, 940 consecutive patients ≤65 years were enrolled. The median follow-up was 31.1 months. The median age was 55 years (range, 25–65 years). The characteristics were comparable between the PORT group and non-PORT group, except that more patients with ≥4 positive lymph nodes and receiving chemotherapy in the PORT group. The 3- and 5-year OS rates were 75.3% and 63.1%, respectively, in the PORT group, which were statistically significantly higher than 68.2% and 53.3% in the non-PORT group (p=0.023). The differences between the two groups were also significant in the DFS and LRFS rates (p=0.006 and 0.000, respectively), but not in the DMFS rate (p=0.062). After adjustment by PSM, PORT still resulted in significantly better survivals of OS, DFS, LRFS and DMFS than non-PORT group (p=0.009, 0.000, 0.000 and 0.000, respectively). Then patients were divided into younger group (≤50 years, n=269), middle-age group (51-55 years, n=218) and older group (56-65 years, n=453). PORT significantly improved the OS in the older group, The 3- and 5-year OS rates were 75.8% and 59.1% in the PORT group vs. 61.5% and 45.7% in the non-PORT group, respectively (p=0.019). The OS was not improved by PORT in the younger or middle-age groups (p=0.859 and 0.524, respectively). When the patients in the younger and middle-age groups was merged together (≤55 years), the OS was not improved by PORT neither (p=0.626). In multivariable analysis, PORT was not significantly associated with better prognosis of patients ≤55 years old (p=0.902). For patients with completely resected pIIIA–N2 NSCLC, PORT can significantly improve the OS of patients aged 56-65 years, but not in patients aged ≤55 years. The result needs to be validated in the future study.

PC04.03 Adjuvant Targeted Therapy for PTS with Genomic Alterations - Yes

PC04.03 Adjuvant Targeted Therapy for PTS with Genomic Alterations - Yes

PLNR&amp;le;20% may be a benefit from PORT for patients with IIIA-N2 NSCLC: a large population-based study

PurposeOur study was to evaluate the influence of positive lymph nodes ratio (PLNR) on survival for patients with pathological stage IIIA-N2 non-small cell lung cancer (NSCLC) after receiving postoperative radiotherapy (PORT).Patients and methodsThe chi-squared test was used to compare the patient baseline characteristics. Cox proportional hazard model was used to analyze the influence of different variables on overall survival (OS). X-tile model was applied to determine the cutoff values of PLNR. Kaplan–Meier method and log-rank test were used to compare survival differences. Based on different cutoff values of PLNR, Cox proportional hazard model was also used to analyze the influence factors on OS.ResultsMultivariate Cox regression analysis showed that PLNR (P=0.001) and PORT (HR=1.283; 95% CI 1.154–1.426; P<0.001) were significant independent prognostic factors for OS in patients with resected IIIA-N2 NSCLC. The X-tile model was used to screen three different cutoff values including PLNR≤20%, 20%<PLNR≤40%, PLNR>40%. Based on these different cutoff values, we found that patients with PLNR≤20% receiving PORT have a better OS (P=0.007). Further multivariable analysis showed that PORT is an independent prognostic factor of OS only for patients with PLNR≤20% (HR=1.328; 95% CI 1.139–1.549; P<0.001). Conclusion: PLNR≤20% may be a prognostic factor for patients with IIIA-N2 NSCLC receiving PORT.

Induction Chemoradiotherapy (50 Gy), Followed by Resection, for Stage IIIA-N2 Non-Small Cell Lung Cancer

The optimal therapeutic strategy for potentially resectable clinical (c-) stage IIIA-N2 non-small cell lung cancer (NSCLC) remains controversial. This phase II multiinstitutional study (West Japan Oncology Group 5308L) was designed to evaluate the feasibility of induction chemotherapy with concurrent thoracic radiotherapy (50 Gy), followed by resection and postoperative consolidation chemotherapy, in IIIA-N2 NSCLC. Patients with resectable c-stage IIIA-N2 were eligible, and pathologic confirmation of N2 disease was mandatory. Patients received chemotherapy consisting of weekly carboplatin plus paclitaxel with concurrent radiotherapy (50 Gy in 25 fractions). Unless disease progression was documented, patients underwent surgical resection, and thereafter received two courses of consolidation chemotherapy with carboplatin plus paclitaxel. The primary end point was the proportion of patients who achieved complete resection after induction chemoradiotherapy (R0 rate). From December 2011 to November 2013, 40 eligible patients were enrolled. All patients completed induction chemoradiotherapy with an overall response rate of 58%, and 32 patients achieved complete resection (R0 rate, 80%) mostly with lobectomy (n= 27). Twenty patients (50%) completed the study treatment, including postoperative chemotherapy. After the median follow-up period of 38 months, the progression-free survival, overall survival, and recurrence-free survival rates at 2 years were 63%, 75%, and 62%, respectively. The 30-day and 90-day mortality were 0%. Induction chemotherapy with concurrent radiotherapy (50 Gy), followed by resection, was a feasible and promising treatment option for resectable c-stage IIIA-N2 NSCLC.

Multimodality therapy in subclassified stage IIIA-N2 non-small cell lung cancer patients according to the Robinson classification: heterogeneity and management.

Non-small cell lung cancer (NSCLC) with mediastinal lymph node involvement (N2) is a heterogeneous entity. The objective of this analysis is to investigate the results of treatment strategies for N2-positive patients. Retrospective study (2009-2014) of 104 consecutive patients with stage IIIA-N2 NSCLC classified according to the Robinson classification (IIIA1-IIIA4) and treated within a multimodality treatment regime. The Robinson subgroups were: IIIA1 (n=27), IIIA3 (n=60) and IIIA4 (n=17). We had no stage IIIA2 samples because we did not perform an intraoperative frozen section of lymph nodes. Surgical resection with systematic lymph node dissection was performed in all patients with stage IIIA1 (n=27). After chemotherapy or chemo-/radiotherapy, 53.3% of patients in stage IIIA3 (n=32) and 11.7% of patients in stage IIIA4 (n=2) underwent surgery with curative intention. R0 was achieved in 92.6% in stage IIIA1, 93.8% in stage IIIA3 and 100% in stage IIIA4. The 30-day mortality was 3.2%. The overall median survival was 31.7 months (5-year survival was 30.5%). There were no significant differences (P=0.583) in survival regarding the Robinson subgroups. Patients who underwent tumour resection had significantly better median survival (39.8 vs. 19.6 months; P=0.014) compared to patients treated conservatively. Deviation from the interdisciplinary recommended therapy (12%) led to a reduced median survival (11.4 vs. 31.8 months; P=0.137). N2-patients should be subclassified according to the Robinson classification and discussed in the tumour board. Surgical resection should be recommended in specific cases of N2-disease (non-bulky, sensitivity to systemic treatment).

Prognosis of multi-level N2-positive non-small cell lung cancer according to lymph node staging using endobronchial ultrasound-transbronchial biopsy.

BackgroundThe optimal treatment for stage IIIA‐N2 non‐small cell lung cancer (NSCLC) remains controversial, and multidisciplinary team approaches are needed. Downstaging after induction therapy is a good prognostic factor in surgical patients; however, re‐evaluation of nodal status before surgery is challenging. The aim of this study was to evaluate the prognosis of patients with multi‐level N2 NSCLC who received surgery or chemoradiation therapy (CRT) according to restaging using endobronchial ultrasound‐transbronchial aspiration (EBUS‐TBNA).MethodsThis was a single center, prospective study that included 16 patients with biopsy‐proven multi‐level N2 disease on initial EBUS‐TBNA that was restaged using EBUS‐TBNA after induction therapy. Cases downstaged after rebiopsy were treated surgically. Three‐year progression‐free survival (PFS) and locoregional PFS were determined using Kaplan–Meier analysis.ResultsOf the 16 patients (median age 58 years, male 63%), eight had persistent N2 disease and eight showed N2 clearance on restaging using EBUS‐TBNA. Ten patients underwent surgery, including two patients without N2 clearance. Recurrence and locoregional recurrence occurred in eight and five patients, respectively. The three‐year PFS was longer in patients with N2 clearance than in those with N2 persistent disease (57.1% vs. 37.5%). Patients with N2 clearance also had longer three‐year locoregional PFS than those with N2 persistent disease (71.4% vs. 62.5%).ConclusionsEBUS‐TBNA could be an effective diagnostic method for restaging in multi‐level N2 NSCLC patients after induction CRT. As this was a pilot study, further large‐scale randomized studies are needed.

Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society)

ObjectivesThe role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT). Material and methodsA total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group). ResultsOf the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p < 0.001) were significantly higher in the CRTS group. This survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup versus dCRT (OS: 57 vs 29 months, p < 0.001; PFS: 46 vs 15 months, p < 0.001), but not in the comparison between the pneumonectomy subgroup and dCRT. ConclusionThe findings reported here indicate that neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy) yields better OS and PFS than definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC.

P2.14-017 Postoperative Radiotherapy in Completely Resected Stage IIIA-N2 Non-Small Cell Lung Cancer

P2.14-017 Postoperative Radiotherapy in Completely Resected Stage IIIA-N2 Non-Small Cell Lung Cancer

PUB030 A Nomogram to Predict the Survival of Stage IIIA-N2 Non-Small Cell Lung Cancer After Surgery

PUB030 A Nomogram to Predict the Survival of Stage IIIA-N2 Non-Small Cell Lung Cancer After Surgery