Pathological status of mediastinal lymph nodes after preoperative concurrent chemoradiotherapy determines prognosis in patients with non-small cell lung cancer.
OBJECTIVE
The benefits of preoperative chemoradiotherapy for advanced nonsmall cell lung cancer (NSCLC) remain controversial. To evaluate prognostic indicators of clinical N2 NSCLC patients treated with concurrent chemotherapy followed by pulmonary resection, we performed a retrospective study.


METHODS
We retrospectively investigated 52 patients with pathologically proven N2 NSCLC who underwent concurrent chemoradiotherapy before pulmonary resection. Each received 2 cycles of cisplatin-vinca alkaloid-based chemotherapy every 4 weeks. Radiotherapy, directed at the tumor and mediastinal nodes, was started on day 2 at a median dose of 44 Gy. A thoracotomy was performed 6 to 8 weeks after completion of chemoradiotherapy.


RESULTS
The overall 5-year survival rate for the 52 patients was 38%. Complete pathological response by the tumor was found in 11 (21%). Down-staging of nodal stage occurred in 29 patients, (56%) and overall survival was better in those with lower pathological N status. The 5-year survival rate was 58% for pathological N0-N1 disease and 0% for N2 disease. While the response to induction therapy by the primary tumor was correlated with postoperative nodal stage, multivariate analysis revealed postoperative nodal stage as an independent prognostic factor.


CONCLUSIONS
Pathological status of mediastinal lymph nodes in response to preoperative concurrent chemoradiotherapy determined prognosis in our patients.
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. yshintani@thoracic.med.osaka-u.ac.jp
Yasushi
Y
Shintani
Yasunobu
Y
Funakoshi
Masayoshi
M
Inoue
Yukiyasu
Y
Takeuchi
Meinoshin
M
Okumura
Hajime
H
Maeda
Mitsunori
M
Ohta
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies