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Semin Respir Crit Care Med 2020; 41(03): 346-353
DOI: 10.1055/s-0039-1698436
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgery as a Component of Multimodality Care for Known Stage IIIA-N2 Non-small Cell Lung Cancer

Adam J. Bograd
1   Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
,
Eric Vallières
1   Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
25. Mai 2020 (online)

    Lizenzen und Reprints

Abstract

Locally advanced, stage IIIA-N2 Non-small cell lung cancer (NSCLC) represents a heterogeneous patient population. Considerable controversy exists as to the optimal management of these patients. Local therapy alone with a single modality, namely surgery or radiation, is associated with high recurrence rates and low overall survival. Consequently, multimodality treatment (chemotherapy, radiotherapy, with or without the utilization of surgery) has developed as a means of both local and systemic control for patients with stage IIIA-N2 NSCLC, and has led to improved overall survival. While it is clear that multimodality therapy is beneficial, the ideal composition of the treatment regimen remains a work in progress. As a result, the optimal management of patients with stage IIIA-N2 NSCLC is widely debated, as is the role for surgery in a multimodality treatment regimen. Herein, we review the current literature supporting multimodality therapy for stage IIIA-N2 NSCLC with an emphasis on the data supporting the role of surgery in resectable and potentially resectable patients.

Keywords

lung cancer - stage IIIA - N2 - multimodality therapy - surgery
 

  • References

  • 1 Pignon JP, Tribodet H, Scagliotti GV. , et al; LACE Collaborative Group. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 2008; 26 (21) 3552-3559
    CrossrefPubMedSuche in Google Scholar
  • 2 Martini N, Kris MG, Flehinger BJ. , et al. Preoperative chemotherapy for stage IIIa (N2) lung cancer: the Sloan-Kettering experience with 136 patients. Ann Thorac Surg 1993; 55 (06) 1365-1373 , discussion 1373–1374
    CrossrefPubMedSuche in Google Scholar
  • 3 Rosell R, Gómez-Codina J, Camps C. , et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med 1994; 330 (03) 153-158
    CrossrefPubMedSuche in Google Scholar
  • 4 Roth JA, Fossella F, Komaki R. , et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl Cancer Inst 1994; 86 (09) 673-680
    CrossrefPubMedSuche in Google Scholar
  • 5 Depierre A, Milleron B, Moro-Sibilot D. , et al; French Thoracic Cooperative Group. Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II, and IIIa non-small-cell lung cancer. J Clin Oncol 2002; 20 (01) 247-253
    PubMedSuche in Google Scholar
  • 6 Gilligan D, Nicolson M, Smith I. , et al. Preoperative chemotherapy in patients with resectable non-small cell lung cancer: results of the MRC LU22/NVALT 2/EORTC 08012 multicentre randomised trial and update of systematic review. Lancet 2007; 369 (9577): 1929-1937
    CrossrefPubMedSuche in Google Scholar
  • 7 van Meerbeeck JP, Kramer GWPM, Van Schil PEY. , et al; European Organisation for Research and Treatment of Cancer-Lung Cancer Group. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 Non-small-cell lung cancer. J Natl Cancer Inst 2007; 99 (06) 442-450
    CrossrefPubMedSuche in Google Scholar
  • 8 Albain KS, Swann RS, Rusch VR. , et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small cell lung cancer HHS public access. Lancet 2009; 374 (9687): 379-386
    CrossrefPubMedSuche in Google Scholar
  • 9 Furuse K, Fukuoka M, Kawahara M. , et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol 1999; 17 (09) 2692-2699
    CrossrefPubMedSuche in Google Scholar
  • 10 Jeremic B, Shibamoto Y, Acimovic L, Milisavljevic S. Hyperfractionated radiation therapy with or without concurrent low-dose daily carboplatin/etoposide for stage III non-small-cell lung cancer: a randomized study. J Clin Oncol 1996; 14 (04) 1065-1070
    CrossrefPubMedSuche in Google Scholar
  • 11 Albain KS, Rusch VW, Crowley JJ. , et al. Concurrent cisplatin/etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small-cell lung cancer: mature results of Southwest Oncology Group phase II study 8805. J Clin Oncol 1995; 13 (08) 1880-1892
    CrossrefPubMedSuche in Google Scholar
  • 12 Eberhardt WEE, Pöttgen C, Gauler TC. , et al. Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA(N2) and selected IIIB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE). J Clin Oncol 2015; 33 (35) 4194-4201
    CrossrefPubMedSuche in Google Scholar
  • 13 Pöttgen C, Eberhardt W, Stamatis G, Stuschke M. Definitive radiochemotherapy versus surgery within multimodality treatment in stage III non-small cell lung cancer (NSCLC) - a cumulative meta-analysis of the randomized evidence. Oncotarget 2017; 8 (25) 41670-41678
    CrossrefPubMedSuche in Google Scholar
  • 14 Tsitsias T, Boulemden A, Ang K, Nakas A, Waller DA. The N2 paradox: similar outcomes of pre- and postoperatively identified single-zone N2a positive non-small-cell lung cancer. Eur J Cardiothorac Surg 2014; 45 (05) 882-887
    CrossrefPubMedSuche in Google Scholar
  • 15 De Leyn P, Dooms C, Kuzdzal J. , et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg 2014; 45 (05) 787-798
    CrossrefPubMedSuche in Google Scholar
  • 16 Scagliotti GV, Fossati R, Torri V. , et al; Adjuvant Lung Project Italy/European Organisation for Research Treatment of Cancer-Lung Cancer Cooperative Group Investigators. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer. J Natl Cancer Inst 2003; 95 (19) 1453-1461
    CrossrefPubMedSuche in Google Scholar
  • 17 The International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non–small-cell lung cancer. N Engl J Med 2004; 350: 351-360
    CrossrefPubMedSuche in Google Scholar
  • 18 Douillard J-Y, Rosell R, De Lena M. , et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol 2006; 7 (09) 719-727
    CrossrefPubMedSuche in Google Scholar
  • 19 Boffa DJ, Hancock JG, Yao X. , et al. Now or later: evaluating the importance of chemotherapy timing in resectable stage III (N2) lung cancer in the National Cancer Database. Ann Thorac Surg 2015; 99 (01) 200-208
    CrossrefPubMedSuche in Google Scholar
  • 20 Stewart LA, Burdett S, Parmar MKB. , et al; PORT Meta-analysis Trialists Group. Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. Lancet 1998; 352 (9124): 257-263
    CrossrefPubMedSuche in Google Scholar
  • 21 Lally BE, Zelterman D, Colasanto JM, Haffty BG, Detterbeck FC, Wilson LD. Postoperative radiotherapy for stage II or III non-small-cell lung cancer using the surveillance, epidemiology, and end results database. J Clin Oncol 2006; 24 (19) 2998-3006
    CrossrefPubMedSuche in Google Scholar
  • 22 Barnett SA, Rusch VW, Zheng J. , et al. Contemporary results of surgical resection of non-small cell lung cancer after induction therapy: a review of 549 consecutive cases. J Thorac Oncol 2011; 6 (09) 1530-1536
    CrossrefPubMedSuche in Google Scholar
  • 23 Andre F, Grunenwald D, Pignon J-P. , et al. Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications. J Clin Oncol 2000; 18 (16) 2981-2989
    CrossrefPubMedSuche in Google Scholar
  • 24 Cho HJ, Kim SR, Kim HR. , et al. Modern outcome and risk analysis of surgically resected occult N2 non-small cell lung cancer. Ann Thorac Surg 2014; 97 (06) 1920-1925
    CrossrefPubMedSuche in Google Scholar
  • 25 Funakoshi Y, Takeuchi Y, Kusumoto H, Kimura T, Maeda H. Which subgroup of patients with pathologic N2 non-small cell lung cancer benefit from surgery?. J Cancer Res Clin Oncol 2012; 138 (06) 1027-1033
    CrossrefPubMedSuche in Google Scholar
  • 26 Misthos P, Sepsas E, Kokotsakis J, Skottis I, Lioulias A. The significance of one-station N2 disease in the prognosis of patients with nonsmall-cell lung cancer. Ann Thorac Surg 2008; 86 (05) 1626-1630
    CrossrefPubMedSuche in Google Scholar
  • 27 Weder W, Collaud S, Eberhardt WEE. , et al. Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non-small-cell lung cancer. J Thorac Cardiovasc Surg 2010; 139 (06) 1424-1430
    CrossrefPubMedSuche in Google Scholar
  • 28 Krasna MJ, Gamliel Z, Burrows WM. , et al. Pneumonectomy for lung cancer after preoperative concurrent chemotherapy and high-dose radiation. Ann Thorac Surg 2010; 89 (01) 200-206 , discussion 206
    CrossrefPubMedSuche in Google Scholar
  • 29 Pless M, Stupp R, Ris HB. , et al; SAKK Lung Cancer Project Group. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet 2015; 386 (9998): 1049-1056
    CrossrefPubMedSuche in Google Scholar
  • 30 Thomas M, Rübe C, Hoffknecht P. , et al; German Lung Cancer Cooperative Group. Effect of preoperative chemoradiation in addition to preoperative chemotherapy: a randomised trial in stage III non-small-cell lung cancer. Lancet Oncol 2008; 9 (07) 636-648
    CrossrefPubMedSuche in Google Scholar
  • 31 Spicer JD, Shewale JB, Nelson DB. , et al. Multimodality therapy for N2 non-small cell lung cancer: an evolving paradigm. Ann Thorac Surg 2019; 107 (01) 277-284
    CrossrefPubMedSuche in Google Scholar
  • 32 Yang CFJ, Gulack BC, Gu L. , et al. Adding radiation to induction chemotherapy does not improve survival of patients with operable clinical N2 non-small cell lung cancer. J Thorac Cardiovasc Surg 2015; 150 (06) 1484-1492
    CrossrefPubMedSuche in Google Scholar
  • 33 Katakami N, Tada H, Mitsudomi T. , et al. A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903). Cancer 2012; 118 (24) 6126-6135
    CrossrefPubMedSuche in Google Scholar
  • 34 Betticher DC, Hsu Schmitz S-F, Tötsch M. , et al. Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small-cell lung cancer: a multicenter phase II trial. J Clin Oncol 2003; 21 (09) 1752-1759
    CrossrefPubMedSuche in Google Scholar
  • 35 Besse B, Adjei A, Baas P. , et al; Panel Members; ESMO. 2nd ESMO Consensus Conference on Lung Cancer: non-small-cell lung cancer first-line/second and further lines of treatment in advanced disease. Ann Oncol 2014; 25 (08) 1475-1484
    CrossrefPubMedSuche in Google Scholar
  • 36 Port JL, Korst RJ, Lee PC. , et al. Surgical resection for residual N2 disease after induction chemotherapy. Ann Thorac Surg 2005; 79 (05) 1686-1690
    CrossrefPubMedSuche in Google Scholar
  • 37 Decaluwé H, De Leyn P, Vansteenkiste J. , et al. Surgical multimodality treatment for baseline resectable stage IIIA-N2 Non-small cell lung cancer. Degree of mediastinal lymph node involvement and impact on survival. Eur J Cardiothorac Surg 2009; 36 (03) 433-439
    CrossrefPubMedSuche in Google Scholar
  • 38 Ripley RT, Suzuki K, Tan KS. , et al. Postinduction positron emission tomography assessment of N2 nodes is not associated with ypN2 disease or overall survival in stage IIIA non-small cell lung cancer. J Thorac Cardiovasc Surg 2016; 151 (04) 969-977 , 979.e1–979.e3
    CrossrefPubMedSuche in Google Scholar