TY - JOUR
T1 - Resectable Clinical N2 Non–Small Cell Lung Cancer; What Is the Optimal Treatment Strategy? An Update by the British Thoracic Society Lung Cancer Specialist Advisory Group
AU - Evison, Matthew
AU - Clive, Amelia
AU - Castle, Lianne
AU - Powell, Helen
AU - Thomas, Rachel
AU - Buttery, Robert
AU - Masani, Vidan
AU - Harden, Susan
AU - West, Doug
AU - Woolhouse, Ian
PY - 2017/9
Y1 - 2017/9
N2 - Patients and clinicians are faced with uncertainty as to the optimal treatment strategy for potentially resectable NSCLC in which there is clinical evidence of involvement of the ipsilateral mediastinum. Randomized controlled trials and meta-analyses have failed to demonstrate superiority of one bimodality strategy over another (chemotherapy plus surgery versus chemotherapy plus radiotherapy). One trial of trimodality treatment with chemotherapy, radiotherapy, and surgery demonstrated an improvement in progression-free, but not overall, survival versus chemotherapy and radiotherapy. There are a number of limitations to the data in this complex and heterogenous patient group. No randomized controlled trial has specifically studied patients with single-station N2 disease versus multistation N2 disease. When discussing treatment for fit patients with potentially resectable cN2 NSCLC, lung cancer teams should consider trimodality treatment with chemotherapy, radiotherapy, and surgery or bimodality treatment with chemotherapy and either surgery or radiotherapy. We advocate that all patients see both a thoracic surgeon and the oncology team to discuss these different approaches.
AB - Patients and clinicians are faced with uncertainty as to the optimal treatment strategy for potentially resectable NSCLC in which there is clinical evidence of involvement of the ipsilateral mediastinum. Randomized controlled trials and meta-analyses have failed to demonstrate superiority of one bimodality strategy over another (chemotherapy plus surgery versus chemotherapy plus radiotherapy). One trial of trimodality treatment with chemotherapy, radiotherapy, and surgery demonstrated an improvement in progression-free, but not overall, survival versus chemotherapy and radiotherapy. There are a number of limitations to the data in this complex and heterogenous patient group. No randomized controlled trial has specifically studied patients with single-station N2 disease versus multistation N2 disease. When discussing treatment for fit patients with potentially resectable cN2 NSCLC, lung cancer teams should consider trimodality treatment with chemotherapy, radiotherapy, and surgery or bimodality treatment with chemotherapy and either surgery or radiotherapy. We advocate that all patients see both a thoracic surgeon and the oncology team to discuss these different approaches.
KW - N2 NSCLC
KW - Non–small cell lung cancer
KW - Radiotherapy
KW - Thoracic surgery
UR - http://www.scopus.com/inward/record.url?scp=85024868551&partnerID=8YFLogxK
U2 - 10.1016/j.jtho.2017.05.023
DO - 10.1016/j.jtho.2017.05.023
M3 - Article
C2 - 28624466
AN - SCOPUS:85024868551
SN - 1556-0864
VL - 12
SP - 1434
EP - 1441
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 9
ER -