N2-IIIA non-small cell lung cancer: a plea for surgery!
Fiche publication
Date publication
novembre 2016
Journal
Journal of thoracic disease
Auteurs
Membres identifiés du Cancéropôle Est :
Pr FALCOZ Pierre-Emmanuel, Pr OLLAND Anne
Tous les auteurs :
Massard G, Renaud S, Reeb J, Santelmo N, Olland A, Falcoz PE
Lien Pubmed
Résumé
Management of stage IIIA-N2 non-small cell lung cancer is still matter of ongoing controversy. The debate is flawed by the heterogeneity of this group of patients, lack of strong evidence from controlled trials, diverging treatment strategies, and hesitating estimation of prognosis. Surgery is credited a survival advantage in a trimodality setting. For many teams, N2 is by principle managed with induction chemotherapy, followed by surgery if the patient is down-staged. However, surgery remains a suitable option even in case of persistent N2. On the other hand, outcomes are comparable, regardless whether chemotherapy has been given as induction or adjuvant treatment. Hence, upfront surgery without invasive staging, followed by adjuvant therapies, appears reasonable in resectable single station N2 disease, simplifying patient care and reducing cost. We expect that molecular biomarkers will improve estimation of prognosis and patient selection in the future.
Référence
J Thorac Dis. 2016 Nov;8(Suppl 11):S849-S854