Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935

Abstract

These data suggest: (1) persistent N2 disease following induction chemotherapy is unfavorable; (2) patients downstaged to N2 negative may benefit from surgical resection; however, (3) 33% of N2 negative patients suffered disease relapse.

Stage IIIA-N2 NSCLC: A review of its treatment approaches and future developments

“…The rate of pathological nodal downstaging is low confirming the low accuracy of radiological response assessment (see further) and a low activity of the induction regimens used. The rate of complete pathological remission with neoadjuvant chemotherapy is lower than with chemoradiotherapy confirming the results of other aforementioned series [30][31][32]. 4.…”

“…The review reported a non-weighted average effect size for radiological response rate of 64% a disease progression of 4% and for histological complete response of 24% of patients. Survival is improved as compared with historical controls and is influenced by patient age complete resection pathologic stage nodal downstaging and extent of resection but not by the type of induction regimen chemo-or chemoradiotherapy [28][29][30].…”

Non–Small Cell Lung Cancer

“…105,106 RT should start earlier, because local recurrence is the most common failure in this group of patients. 107 Conformal RT with or without chemotherapy should be offered to patients with curable stages I through III NSCLC who are medically inoperable but have reasonable PS and life expectancy. 108 Modern 3-dimensional conformal RT techniques with CT or CT/PET-based treatment planning should be used on all patients.…”

Endobronchial/Endoesophageal Ultrasound (EBUS/EUS) Guided Fine Needle Aspiration (FNA) and 18F-FDG PET/CT Scanning in Restaging of Locally Advanced Non-small Cell Lung Cancer (NSCLC) Treated with Chemo-radiotherapy

“…Clearance of mediastinal lymph node (LN) metastases is the most important prognostic factor in the prediction of longterm survivors after chemo-radiotherapy in patients with locally advanced non-small cell lung cancer (NSCLC) (1)(2)(3). To date, the most effective strategy for cleaning mediastinal LN from metastasis seems to be the administration of chemotherapy concomitantly with radiotherapy (4,5).…”