Reviewer: James M. Metz, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: July 5, 2005
Presenter: J. van Meerbeeck
Presenter's Affiliation: University Hospital, Ghent, Belgium
Type of Session: Plenary
There remains significant controversy in the optimal treatment of patients with locally advanced stage IIIA NSCLC with ipsilateral mediastinal lymph node involvement (N2). Chemotherapy has shown significant response rates in this disease. Radiation therapy, when combined with chemotherapy can improve on the outcomes. It remains controversial if patients benefit from surgical resection after induction therapy in patients with N2 disease. This trial, which was also reported at ASCO 2005, was designed to compare surgical resection to radiation therapy after induction chemotherapy in responding patients.
Materials and Methods
This is an important study that contributes significantly to our knowledge in the treatment of IIIA NSCLC. The results of this study mirror those of the recently reported US Intergroup study. In the Intergroup study patients initially received induction treatment with cisplatin/etoposide/TRT and were then randomized to either surgical resection or completion of definitive radiation therapy. After 81 months of follow-up there was no benefit to the addition of surgery. However, patients who received a pnuemonectomy did significantly worse while those that had a lobectomy did better. In the current EORTC study, there was no benefit found for the addition of surgery over radiation therapy. The EORTC has decided to make chemotherapy and radiation therapy the standard arm for future trials of N2 disease. Taken together, these two studies help further refine the treatment of IIIA NSCLC. At the current time, patients with macroscopic N2 disease or disease requiring a pneumonectomy should be offered definitive chemotherapy and radiation therapy without surgery. Selected patients with minimal or microscopic N2 disease that would need a lobectomy may be considered for surgical resection after induction therapy.