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H. Hofmann



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    P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      P1.03-002 - Surgery in Subclassified Stage IIIA-N2 Lung Cancer Improves Survival (ID 1071)

      09:30 - 17:00  |  Author(s): H. Hofmann

      • Abstract
      • Slides

      Background:
      Lung cancer with mediastinal lymph node involvement (N2) is a heterogeneous entity. The Robinson-classification subdivided these N2-patients in four groups (IIIA~1~-IIIA~4~). Objective of this analysis was to investigate the result of strict treatment strategies for N2-patients determined by the interdisciplinary tumorboard.

      Methods:
      Retrospective study and survival analysis of 118 consecutive patients with stage IIIA-N2 lung cancer classified according to the Robinson-classification and treated within a multimodality treatment regime between January 2009 and June 2014. All patients were evaluated and discussed in an interdisciplinary lung tumorboard and a therapy recommendation was made based on the Interdisciplinary Guideline of the German Respiratory Society and German Cancer Society.

      Results:
      Robinson subgroups were: IIIA~1~ (n= 28; mean age 60.4 years), IIIA~3~ (n= 70; mean age 63 years) and IIIA~4~ (n= 20; mean age 64.4 years). We have no stage IIIA~2~, because we did not perform an intraoperative frozen section of mediastinal lymph nodes. Surgical resection with systematic lymph node dissection was performed in all patients with stage IIIA~1~ (n= 28). After induction chemotherapy or chemo-/radiotherapy, 47% of patients in IIIA~3~ (n= 33) and 10% of patients in IIIA~4~ (n= 2) could be operated with curative intention. Complete tumor resection (R0) was achieved in 93% (n= 26) in stage IIIA~1~, in 94% (n= 31) in stage IIIA~3~ and in 100% (n= 2) in stage IIIA~4~. Operative mortality within 30 days was 3.17%. Overall median survival was 29.8 months. The 3- and 5-year survivals were 44.9% and 28.5%, respectively, in all patients with stage IIIA-N2 disease. There were no significant differences (p= 0.477) in survival regarding the Robinson subgroups. Patients who underwent surgical tumor resection had a significant better median survival (43.6 vs. 22.8 months; p= 0.013) compared to patients treated conservatively. In addition, patients in stage IIIA~3~ who were considered for surgery after induction therapy had a significant better median survival according to non-surgically treated patients (45.4 vs. 22.8 months; p= 0.014) and they had the good overall survival of IIIA~1~ patients (3- and 5-year survival rates of 59.4% and 40.8%). Deviation of the interdisciplinary recommended therapy (n= 15) lead to a significant reduced median survival (12.9 vs. 31.9 months; p= 0.011) compared to implementation of the suggested treatment approach (n= 100).

      Conclusion:
      Stage IIIA-N2-patients should be classified according to the Robinson-classification and discussed in the tumorboard. The treatment recommendation should be respected, because enforcement of the interdisciplinary recommended therapy significantly impacts survival. Surgical resection did lead to significant better survival rates. All stage IIIA~3~ and IIIA~4~ patients should be reevaluated for surgery depending on their response to induction therapy.

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