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Glatzer M, Leskow P, Caparrotti F, Elicin O, Furrer M, Gambazzi F, Dutly A, Gelpke H, Guckenberger M, Heuberger J, Inderbitzi R, Cafarotti S, Karenovics W, Kestenholz P, Kocher GJ, Kraxner P, Krueger T, Martucci F, Oehler C, Ozsahin M, Papachristofilou A, Wagnetz D, Zaugg K, Zwahlen D, Opitz I, Putora PM. Stage III N2 non-small cell lung cancer treatment: decision-making among surgeons and radiation oncologists. Transl Lung Cancer Res 2021; 10:1960-1968. [PMID: 34012806 PMCID: PMC8107728 DOI: 10.21037/tlcr-20-1210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Stage III N2 non-small cell lung cancer (NSCLC) is a very heterogeneous disease associated with a poor prognosis. A number of therapeutic options are available for patients with Stage III N2 NSCLC, including surgery [with neoadjuvant or adjuvant chemotherapy (CTx)/neoadjuvant chemoradiotherapy (CRT)] or CRT potentially followed by adjuvant immunotherapy. We have no clear evidence demonstrating a significant survival benefit for either of these approaches, the selection between treatments is not always straightforward and can come down to physician and patient preference. The very heterogeneous definition of resectability of N2 disease makes the decision-making process even more complex. Methods We evaluated the treatment strategies for preoperatively diagnosed stage III cN2 NSCLC among Swiss thoracic surgeons and radiation oncologists. Treatment strategies were converted into decision trees and analysed for consensus and discrepancies. We analysed factors relevant to decision-making within these recommendations. Results For resectable “non-bulky” mediastinal lymph node involvement, there was a trend towards surgery. Numerous participants recommend a surgical approach outside existing guidelines as long as the disease was resectable, even in multilevel N2. With increasing extent of mediastinal nodal disease, multimodal treatment based on radiotherapy was more common. Conclusions Both, surgery- or radiotherapy-based treatment regimens are feasible options in the management of Stage III N2 NSCLC. The different opinions reflected in the results of this manuscript reinforce the importance of a multidisciplinary setting and the importance of shared decision-making with the patient.
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Affiliation(s)
- Markus Glatzer
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Pawel Leskow
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Francesca Caparrotti
- Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Markus Furrer
- Department of Vascular and Thoracic Surgery, Kantonsspital Chur, Chur, Switzerland
| | - Franco Gambazzi
- Department of Thoracic Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - André Dutly
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Gelpke
- Department of Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jürg Heuberger
- Department of Radiation Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Peter Kestenholz
- Department of Thoracic Surgery, Kantonsspital Luzern, Luzern, Switzerland
| | - Gregor Jan Kocher
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Kraxner
- Department of Radiation Oncology, Kantonsspital Luzern, Luzern, Switzerland.,Department of Radiation Oncology, Kantonsspital Chur, Chur, Switzerland
| | - Thorsten Krueger
- Department of Thoracic Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Francesco Martucci
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Switzerland
| | - Christoph Oehler
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Dirk Wagnetz
- Department of Visceral-Vascular and Thoracic Surgery, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Radiation Oncology, University of Bern, Bern, Switzerland
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Foucault C, Mordant P, Grand B, Achour K, Arame A, Dujon A, Le Pimpec Barthes F, Riquet M. Unexpected extensions of non-small-cell lung cancer diagnosed during surgery: revisiting exploratory thoracotomies and incomplete resections. Interact Cardiovasc Thorac Surg 2013; 16:667-72. [PMID: 23343836 DOI: 10.1093/icvts/ivs512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Only patients with a complete resection of non-small-cell lung cancer (NSCLC) may expect long-term survival. Despite the recent progress in imaging and induction therapy, a thoracotomy may remain exploratory or with incomplete resection (R2). Our purpose was to revisit these situations. METHODS A total of 5305 patients who underwent surgery for NSCLC between 1980 and 2009 were reviewed. We compared the epidemiology, pathology, causes and prognosis characteristics of exploratory thoracotomy (ET) and R2 resections. RESULTS ET and R2 resections were observed in 223 (4%) and 197 (4%) patients, respectively. The frequency of ET decreased with time, while the frequency of R2 resection remained almost stable. The indications for ET and R2 resections were not significantly different. In comparison with ET, R2 resections were characterized by a significantly higher frequency of induction therapy (22 vs 17%, P < 10(-3)), adenocarcinomas (49 vs 15%, P < 10(-6)), T1-T2 (53 vs 29%, P < 10(-6)) and N0-N1 extension (67 vs 42%, P = 10(-6)). R2 resections were also characterized by a higher rate of postoperative complications (19.1 vs 9.9%, P = 0.014), with no significant difference in postoperative mortality (6.9 vs 4.9%, P = non significant). R2 resections resulted in a higher 5-year survival compared with ET (11.1 vs 1.2%, P = 10(-3)). There was no long-term survivor after ET, except during the last decade. CONCLUSIONS ET and R2 remain unavoidable. In comparison with ET, R2 resection is associated with a higher rate of postoperative complications, but a higher long-term survival.
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Affiliation(s)
- Christophe Foucault
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
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