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Byungkyun Ko

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    P3.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 983)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.17-04 - Dealing with the N2 Disesase in Non- Small Cell Lung Cancer- on the Edge. (ID 13071)

      12:00 - 13:30  |  Author(s): Byungkyun Ko

      • Abstract
      • Slides


      The current guidelines for the evaluation of mediastinal lymph nodes in the setting of lung cancer include EBUS with fine-needle aspiration and cytological evaluation to be enlarged on computed tomography (CT; short axis ≥1 cm). Optimal management of clinical stage IIIA (N2) NSCLC is controversial. This study is a systematic review and meta-analysis of published randomized control trials of multimodality management strategies for NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We conducted a comprehensive literature search of the Pubmed databases for relevant studies comparing patients with stage IIIA (N2) NSCLC undergoing surgery alone, chemotherapy and/or radiotherapy alone, or surgical resection after neoadjuvant treatment with chemotherapy and/or radiotherapy. We estimated hazard ratios, odds ratios (ORs), and 95% confidence intervals (CIs) for survival data.

      4c3880bb027f159e801041b1021e88e8 Result
      Author treat No Median OS 3 ys surv p Median DFS p
      Albain et al S 202 23.6 37.9 0.24 12.8 0.017
      CRT 194 22.2 33.9 10.5
      Van Meerbeek et al S 167 16.4 24.9 0.596 17.2 0.605
      CRT 165 17.5 27.8 15.8
      Katakami et al CRT 29 39.6 51.7 >0.05 12.4 0.187
      Cht 29 29.9 39.3 9.7
      Girad et al CRT 32 - 51.8 - 17.2 -
      Cht 14 24.2 25.4 12.5

      There was no significant difference in overall survival (OS) or progression-free survival (PFS) in stage IIIA (N2) NSCLC patients who received neoadjuvant chemotherapy or chemoradiotherapy prior to surgical resection compared to those who received neoadjuvant chemotherapy or chemoradiotherapy prior to radical radiotherapy. There was a significant increase in pathological complete remission in the mediastinal lymph nodes in stage IIIA (N2) NSCLC patients who received neoadjuvant chemoradiotherapy prior to surgical resection compared to those who received neoadjuvant chemotherapy.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In general, North American surgeons are more likely to surgically stage the mediastinum before operation,
      are less likely to offer surgical treatment when N2 disease is identified preoperatively and are more likely to use induction therapy
      before resection. In contrast, European surgeons may offer operation as the initial treatment followed by adjuvant therapy in
      selected cases of N2 disease, and they may perform a more aggressive intraoperative nodal dissection. Neoadjuvant chemotherapy and/or radiotherapy prior to surgical resection do not appear to be clinically superior to neoadjuvant chemotherapy and/or radiotherapy prior to definitive radiotherapy in IIIA (N2) NSCLC patients


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