280 Results of surgical resection in stage IIIB non-small cell lung cancer (NSCLC) after concomitant induction chemoradiotherapy

Surgery after multimodality treatment for non-small-cell lung cancer

“…Different to our results, SWOG did find significantly better survival results for the stage subgroup T4N0/1. Other investigators, Choi from Boston and Grunenwald from Paris, have also included IIIB patients into tri-modality protocols (T4 as well as N3), comparable to our trial and that of SWOG [8,9,14]. However, in the Boston study the induction chemoradiotherapy was more intensive with a complex irradiation scheme of combining once-with twice-daily irradiation up to 60 Gy.…”

“…Other investigators have focussed on an early intensification of preoperative downstaging by so-called "bimodality induction", including chemotherapy as well as radiation therapy prior to surgery [11][12][13][14]. This approach seems to be especially attractive for more locally advanced selected IIIB subgroups, where a maximum of preoperative downstaging is mandatory in order to enable a complete resection of any vital tumour, left after induction -mostly at areas of bulky disease in the primary tumour or the mediastinum.…”

Surgery for advanced stage lung cancer

“…In addition, an extensive bilateral lymphadenectomy can be performed through an anterior midline sternotomy, possibly extending as far as the cervical areas in the case of supraclavicular N3 [15]. Such a mediastinal dissection results in a devascularization of the mediastinal structures, mainly the bronchial stump, and combined with the harmful effects of pre-operative radiotherapy-and possibly chemotherapy-can induce an increased risk of defects in bronchial healing, resulting in bronchial fistula [13,16,17].…”

“…Trans-sternal bilateral lymphadenectomy, extended to the supraclavicular areas if needed, is technically feasible [15]. A superior vena cava invasion can be resected, with or without prosthetic bypass [24].…”

“…Finally, some locally advanced initially unresectable tumors (IIIb) can become operable after induction chemoradiotherapy [13,14,15]. In a prospective series at the Institut Montsouris, 40 Stage IIIb patients were treated by induction bifractionated accelerated chemoradiation followed by extensive surgery including bilateral medias- Stage IV A B A B C T1N0 T1N1 T3N0 T3N1 T4 1 No-N2 T4 2 N0-N3 T1-T4N0-N3M1 T2N0 T2N1 T1-T3mN2 T1-T3cN2 T1-T4N3 '' tinal lymphadenectomy performed through midline sternotomy.…”