Author of

• 10643

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  P1.07 - Poster Session 1 - Surgery (ID 184)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P1.07-036 - Is radiotherapy unavoidable for N2 disease in NSCLC (ID 2352)

    09:30 - 09:30  |  Author(s): C.S. Pramesh
    • Abstract

    Background
    The ideal treatment for N2 disease in NSCLC is a subject of controversy. The treatment policy followed by individual institutes is generally a reflection of physician preference and physical characteristics of the patient population. In view of stronger evidence supporting neoadjuvant chemotherapy and the desire to reserve one modality of treatment it has been the policy in our institution to administer neoadjuvant chemotherapy followed by surgery in all pathologically proven cases of N2 disease. We conducted a retrospective analysis to asses the pathological response of mediastinal lymph nodes to neoadjuvant chemotherapy and the need for adjuvant radiotherapy in this patient population.

    Methods
    Data from a prospectively maintained database from August 2009 to March 2013 was analyzed. Information regarding number of patients detected to be N2 on mediastinoscopy, patients advised neoadjuvant chemotherapy, number of lymph node stations affected, curative resections, pathological response in mediastinal nodes and adjuvant treatment advised was retrieved. The rate of complete response after neoadjuvant therapy and patients advised postop radiotherapy were calculated as percentages

    Results
    231 patients underwent mediastinoscopy for operable NSCLC. 36 patients were detected to have N2 lymph nodes of which 29 patients were advised neoadjuvant chemotherapy. The remaining patients were advised definitive chemoradiation in view of significant nodal disease precluding R0 resection. 13/17 patients with single station lymphadenopathy underwent curative resection with 8 (61%)patients achieving complete pathological response in the mediastinal nodes. 8/9 patients with multiple station lymphadenopathy also underwent resection with only 2(25%) patients achieving complete pathological response. 11/21(52%) patients who underwent R0 resection after neoadjuvant therapy were advised post operative radiotherapy in view of residual disease in mediastinal nodes while 6/8 (75%) patients with multistation lymphadenopathy required postoperative radiotherapy

    Conclusion
    Patients with resectable multistation mediastinal lymphadenopathy on preoperative invasive mediastinal staging have a very high likelyhood of having residual viable disease in the mediastinal nodes even after neoadjuvant chemotherapy. In this subset of patientss radiotherapy should be incorporated in to the treatment strategy at the outset, to achieve mediastinal steriilization. The ideal timing of radiotherapy neoadjuvant or post operative needs more study. In patients with single station lymphadenopathy neoadjuvant chemotherapy with surgery may be an adequate strategy with radiation reserved for those with residual disease.