Perspectives on the effect of nodal downstaging and its implication of the role of surgery in stage IIIA (N2) non-small cell lung cancer

Martin, Linda W.; Mehran, Reza J.

doi:10.21037/jtd.2017.06.24

Cited by 3 publications

(4 citation statements)

References 32 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of note, N2 disease (mediastinal disease ipsilateral side to the primary tumour) is considered to be the most important prognostic factor in those with potentially resectable lung cancer. This is because this subset of patients is more likely to develop local and distant relapse [10]. Our groups had no significant difference in the rate of N2 disease, and a relatively similar rate of downstaging of mediastinal disease after CRT compared to other studies has also shown, with rates ranging between 16.7 and 50% in the three groups [11][12][13][14][15].…”

Section: Discussionsupporting

confidence: 62%

“…It seems (from the literature) that patients without nodal downstaging and no progression of disease post-CRT seem to have better outcomes with surgery than with no treatment [10]. Others have suggested that after surgical resection, the survival rate is maintained in patients with persistent N2 disease who have undergone definitive CRT; this suggests surgery may have acceptable outcomes despite nodal disease or lack of downstaging.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multimodality Treatment and Salvage Surgery for the Treatment of Lung Cancer

Choi

Tocco

Smith

et al. 2023

Cancers

View full text Add to dashboard Cite

Lung cancer remains the leading cause of cancer deaths in the United Kingdom. For locally advanced disease, multimodality treatment is recommended, which includes a combination of chemotherapy, radiotherapy, surgery and, more recently immunotherapy. Options depend on the resectability of the cancer and there has been debate about the optimal treatment strategy: surgery may be planned to follow chemoradiotherapy (CRT), be offered for residual disease after CRT, or given as salvage therapy for patients treated with CRT who have later relapse of their disease. We conducted a retrospective analysis of all patients who underwent CRT and surgical resection under a single surgical team and performed a descriptive study after dividing the patients into these three groups. For the planned trimodality group, 30-day mortality this was 7% (n = 1) and 1-year survival was 78.6%; the residual disease group had a 30-day mortality rate of 0% and 1-year survival of 81.3%; for the salvage group, the figures were 0% and 62.5%, respectively. The median overall survival of the study population was 35.8 months. Median overall survival in the trimodality group was 35.4 months (20.1–51.7 interquartile range IQR), for the residual group was 34.2 months (18.5–61.0 IQR). and for the salvage group was 35.8 months (32.4–52.7 IQR).)

show abstract

Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Multimodality Treatment and Salvage Surgery for the Treatment of Lung Cancer

Choi

Tocco

Smith

et al. 2023

Cancers

View full text Add to dashboard Cite

show abstract

“…Conventionally, alternative medical treatment or radiotherapy may be administrated as second‐ or third‐line therapy, although the effect is usually unpredictable and poor . On the other hand, there are some patients having had their NSCLC converted from an advanced to resectable stage as a result of targeted therapy, that salvage surgery may be another alternative option for tumor recurrence or residual tumor after targeted therapy …”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] On the other hand, there are some patients having had their NSCLC converted from an advanced to resectable stage as a result of targeted therapy, that salvage surgery may be another alternative option for tumor recurrence or residual tumor after targeted therapy. 14 Salvage surgery already plays a role in the treatment of esophageal cancer, colorectal cancer and other tumors. [15][16][17] In recent years, salvage surgery has also been introduced into the treatment strategy of advanced lung cancer after chemotherapy/radiotherapy failure.…”

Section: Introductionmentioning

confidence: 99%

Salvage surgery for advanced non‐small cell lung cancer after targeted therapy: A case series

et al. 2020

View full text Add to dashboard Cite

Background Tumor recurrence or residual tumor after targeted therapy is common in patients with advanced non‐small cell lung cancer (NSCLC). There is a lack of high‐level evidence on which type of treatment should be employed for these patients and the role of salvage surgery has not been well reported in the literature. Methods A retrospective analysis of patients who underwent salvage surgery in our center between January 2016 and June 2019 for advanced NSCLC after targeted therapy was performed. Results A total number of nine patients were identified, including five males and four females, with a median age of 56 years (range, 40–65 years), all diagnosed with lung adenocarcinoma stage IIIa–IVb. All patients had received targeted therapy according to individual positive mutation of driver gene(s). Salvage surgery was performed for tumor recurrence or residual tumor after a duration of 2–46 months of targeted therapy. A negative surgical margin was achieved in all cases. Postoperative complication rate was 11.1% (1/9). All patients were alive at the time of this analysis and two patients had disease progression. After a median follow‐up of 17 months (range: 5–44 months), the median event‐free survival and postoperative survival was 14 months (range: 2–44 months) and 17 months (range: 5–44 months) respectively. Conclusions Salvage surgery may be a feasible and promising therapeutic option for tumor recurrence or residual tumor in advanced NSCLC in selective patients after targeted therapy. Key points Salvage surgery is feasible in selected patients with advanced NSCLC and provides promising survival outcomes after targeted therapy failure. Salvage surgery provides precise molecular and pathological information which is most important for subsequent therapy.

show abstract