title: The multimodal management of locally advanced N2 non-small cell lung cancer: is there a role for surgical resection? A single institution's experience.
abstract: BACKGROUND
  The management of operable locally advanced N2 non-small cell lung cancer (NSCLC) is a controversial topic. Concurrent chemoradiation (CT-RT) is considered the standard of care for inoperable or unresectable patients, but the role of trimodality treatment remains controversial. We present our institution's experience with the management of stage III (N2) NSCLC patients, analyzing whether the addition of surgery improves survival when compared with definitive CT-RT alone.
  
  
  METHODS
  From 1996 to 2006, 72 N2 NSCLC patients were treated. Thirty-four patients received cisplatin-based induction chemotherapy, followed by paclitaxel-cisplatin CT-RT, and 38 patients underwent surgery preceded by induction and/or followed by adjuvant therapy. Survival curves were estimated by Kaplan-Meier analysis, and the differences were assessed with the log-rank test.
  
  
  RESULTS
  Most of the patients (87 %) were men. The median age was 59 years. A statistically significant association between T3-T4c and definitive CT-RT as well as between T1-T2c and surgery was noted (p < 0.0001). After a median follow-up period of 35 months, the median overall survival (OS) was 42 months for the surgery group versus 41 months for the CT-RT patients (p = 0.590). The median progression-free survival (PFS) was 14 months after surgery and 25 months after CT-RT (p = 0.933). Responders to radical CT-RT had a better OS than non-responders (43 vs. 17 months, respectively, p = 0.011). No significant differences were found in the OS or PFS between the pN0 [14 (37.8 %) patients] and non-pN0 patients at thoracotomy. Three treatment-related deaths (7.8 %) were observed in the surgical cohort and none in the CT-RT group.
  
  
  CONCLUSIONS
  The addition of surgery did not render a median OS or PFS benefit when compared with CT-RT alone in our series of stage III-N2 NSCLC patients, in accordance with previously published data. However, responses to CT-RT had a greater impact in terms of OS and PFS. Although the patients selected for management including surgery showed a favorable T clinical staging in comparison to patients exclusively treated with definitive CT-RT, similar survival outcomes were found.
authors.affiliation: Department of Medical Oncology, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bosch-Barrera
authors.forename: Carlos
authors.initials: C
authors.lastname: García-Franco
authors.forename: Francisco
authors.initials: F
authors.lastname: Guillén-Grima
authors.forename: Marta
authors.initials: M
authors.lastname: Moreno-Jiménez
authors.forename: José María
authors.initials: JM
authors.lastname: López-Picazo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gúrpide
authors.forename: José Luis
authors.initials: JL
authors.lastname: Pérez-Gracia
authors.forename: Javier
authors.initials: J
authors.lastname: Aristu
authors.forename: Wenceslao
authors.initials: W
authors.lastname: Torre
authors.forename: Jesús
authors.initials: J
authors.lastname: García-Foncillas
authors.forename: Ignacio
authors.initials: I
authors.lastname: Gil-Bazo
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged