Author of

• 14451

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  P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Treatment of Locoregional Disease – NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 14468

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    P2.03-017 - Pre-Operative Chemotherapy Followed by Surgery for N2 Non-Small Cell Lung Cancer: A 15-Year Experience (ID 3152)

    09:30 - 09:30  |  Author(s): J. Shewale
    • Abstract

    Background:
    The ideal approach to patients with N2 non-small cell lung cancer (NSCLC) remains controversial. While pathological confirmation of nodal status is advocated, in clinical practice patients with suspicious radiographic evidence of N2 disease are frequently assigned to pre-operative therapy without pathological confirmation. Herein, we review our experience with pre-operative chemotherapy followed by surgery in patients with N2 NSCLC and compare outcomes of biopsy proven N2 disease and those patients who were diagnosed based on PET/CT alone.
    
    Methods:
    A prospectively entered institutional database was accessed to identify all patients with N2 NSCLC treated by pre-operative chemotherapy followed by surgery from 1999 to 2014. Data were verified by chart review. Patients without biopsy or PET-based evidence of N2 disease were excluded.
    
    Results:
    We identified 113 patients of whom 57 had biopsy proof of cN2 and 56 were cN2 based on PET-positivity. See Table 1 for patient demographic and clinico-pathologic variables. Median survival for the cohort was 53.3 months and there was only 1 (0.88%) peri-operative death at 90 days. Three and 5-year survival rates were 63.8% and 39.7%, respectively. Locoregional recurrences occurred in 16.8% of patients. Induction chemotherapy resulted in a significant PET response (SUV reduction > 6) in 38.5% of cases (15/39) where pre- and post-treatment imaging was available. Only 8.77% of patients remained pN2 after pre-operative chemotherapy in those patients who had pre-treatment pathological confirmation. No survival differences were noted between patients with biopsy proven N2 and those with PET-positive N2 nodes (Figure 1).

    Demographic and clinico-pathologic variables.

    Variables	Biopsy proven N2 (N=57)	PET positive N2 (N=56)	P value	Total cohort (N=113)
    Median age (range)	64(38-80)	62(43-77)	0.763	63(38-80)
    Male gender	25(46.3)	28(54.90)	0.378	53(50.48)
    Mean FEV1 (%pred)	85.78	86.54	0.798	86.16
    Mean DLCO (%pred)	81.89	82.28	0.916	82.08
    Type of surgery			0.743
    Wedge/Segmentectomy	3(5.26)	4(7.14)		7(6.19)
    Lobectomy	48(84.21)	44(78.57)		92(81.42)
    Pneumonectomy	6(10.53)	8(14.29)		14(12.39)
    Post-operative treatment			0.094
    None	24(42.11)	27(48.21)		51(45.13)
    Chemo	1(1.75)	15(26.79)		6(5.31)
    Radiation	6(5.31)	9(16.07)		41(36.28)
    Chemoradiation	6(10.53)	9(16.07)		9(16.07)
    Pathological N stage			0.090
    N0	20(35.09)	22(39.29)		42(37.17)
    N1	32(56.14)	22(39.29)		54(47.79)
    N2	5(8.77)	12(21.43)		17(15.04)

    Figure 1
    
    
    
    Conclusion:
    Pre-operative chemotherapy followed by surgery for N2 NSCLC in a well-selected cohort results in good short and long-term outcomes. When pathological confirmation of N2 disease requires invasive staging, it may be acceptable to forgo such tests without compromising patient outcomes. Further prospective studies are needed to determine the ideal treatment regimen for these complex patients.