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

Matthew Evison, Amelia Clive, Lianne Castle, Helen Powell, Rachel Thomas, Robert Buttery, Vidan Masani, Susan Harden, Doug West, Ian Woolhouse

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11 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1434-1441
Number of pages8
JournalJournal of Thoracic Oncology
Volume12
Issue number9
DOIs
Publication statusPublished - Sep 2017
Externally publishedYes

Keywords

  • N2 NSCLC
  • Non–small cell lung cancer
  • Radiotherapy
  • Thoracic surgery

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