title: N2-IIIA non-small cell lung cancer: a plea for surgery!
abstract: Management of stage IIIA-N2 non-small cell lung cancer is still matter of ongoing controversy. The debate is flawed by the heterogeneity of this group of patients, lack of strong evidence from controlled trials, diverging treatment strategies, and hesitating estimation of prognosis. Surgery is credited a survival advantage in a trimodality setting. For many teams, N2 is by principle managed with induction chemotherapy, followed by surgery if the patient is down-staged. However, surgery remains a suitable option even in case of persistent N2. On the other hand, outcomes are comparable, regardless whether chemotherapy has been given as induction or adjuvant treatment. Hence, upfront surgery without invasive staging, followed by adjuvant therapies, appears reasonable in resectable single station N2 disease, simplifying patient care and reducing cost. We expect that molecular biomarkers will improve estimation of prognosis and patient selection in the future.
authors.affiliation: Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 7293 "Vascular and Tissular Stress in Transplantation", Translational Research Federation, Strasbourg University, Strasbourg, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Massard
authors.affiliation: Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 3430 "Tumour progression and microenvironment", Translational Research Federation, Strasbourg University, Strasbourg, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Renaud
authors.affiliation: Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 7293 "Vascular and Tissular Stress in Transplantation", Translational Research Federation, Strasbourg University, Strasbourg, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Reeb
authors.affiliation: Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Nicola
authors.initials: N
authors.lastname: Santelmo
authors.affiliation: Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 7293 "Vascular and Tissular Stress in Transplantation", Translational Research Federation, Strasbourg University, Strasbourg, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Olland
authors.affiliation: Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
keywords: Non-small cell lung cancer; multimodality treatment; stage IIIA-N2; surgery