title: Management of stage IIIA non-small cell lung cancer by thoracic surgeons in North America.
abstract: BACKGROUND
  Stage IIIA(N2) non-small cell lung cancer is a heterogeneous spectrum ranging from microscopic lymph node metastases to bulky multistation nodal disease. While some favor surgical resection after neoadjuvant therapy, others favor definitive chemoradiation for treatment. Our aim was to determine practice patterns of thoracic surgeons.
  
  
  METHODS
  We invited 2,539 active surgeons identified on the Cardiothoracic Surgery Network as expressing interest in general thoracic surgery to participate in an anonymous Web-based survey. The participants evaluated clinical vignettes of a patient with single station N2 disease.
  
  
  RESULTS
  In all, 513 surgeons (20%) responded, with 222 (43%) in academic practice. For microscopic N2 disease, 84% (n=430) preferred neoadjuvant therapy followed by surgery. For grossly involved N2 disease, 62% (n=318) favored neoadjuvant therapy followed by surgery if N2 disease was downstaged. In patients with normal pulmonary function tests, requiring pneumonectomy, in the presence of bulky, single station N2 disease, there was less consensus: 32% (n=163) favored neoadjuvant therapy followed by lobectomy (less radical surgery than initially predicted) if feasible and N2 disease had downstaged, 30% (n=159) favored neoadjuvant therapy followed by pneumonectomy if N2 disease downstaged, 12% (n=60) would favor surgery regardless of N2 disease downstaging, and 22% (n=114) favored definitive chemoradiation. If the patient did not have adequate pulmonary function for pneumonectomy but could tolerate lobectomy, 50% favored neoadjuvant therapy followed by reassessment for lobectomy and 41% favored definitive chemoradiation.
  
  
  CONCLUSIONS
  There is no clear consensus on management of patients with stage IIIA lung cancer in the United States. Diversity of opinion is greatest in patients with more advanced lung cancer, and limited pulmonary function.
authors: Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7065, USA. nirmalv@med.unc.edu
authors: Nirmal K
authors: NK
authors: Veeramachaneni
authors: Richard H
authors: RH
authors: Feins
authors: Briana J K
authors: BJ
authors: Stephenson
authors: Lloyd J
authors: LJ
authors: Edwards
authors: Felix G
authors: FG
authors: Fernandez
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D019090:Case Management / Q000592:standards / Q000639:trends; D059248:Chemoradiotherapy / Q000592:standards / Q000639:trends; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000592:standards* / Q000639:trends; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009656:North America; D011013:Pneumonectomy / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome