Comment on "Treatment of Non-small Cell Lung Cancer Stage IIIA: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition)" Response

University of South Florida, Tampa, Florida, United States
Chest (Impact Factor: 7.48). 10/2007; 132(3 Suppl):243S-265S. DOI: 10.1378/chest.07-1379
Source: PubMed


Stage IIIA non-small cell lung cancer represents a relatively heterogeneous group of patients with metastatic disease to the ipsilateral mediastinal (N2) lymph nodes and also includes T3N1 patients. Presentations of disease range from apparently resectable tumors with occult microscopic nodal metastases to unresectable, bulky multistation nodal disease. This review explores the published clinical trials to make treatment recommendations in this controversial subset of lung cancer.Design, setting, and participants: Systematic searches were made of MEDLINE, HealthStar, and Cochrane Library databases up to May 2006, focusing primarily on randomized trials, with inclusion of selected metaanalyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables.
The evidence derived from the literature now appears to support routine adjuvant chemotherapy after complete resection of stage IIIA lung cancer encountered unexpectedly at surgery. However, using neoadjuvant therapy followed by surgery for known stage IIIA lung cancer as a routine therapeutic option is not supported by current published randomized trials. Combination chemoradiotherapy, especially delivered concurrently, is still the preferred treatment for prospectively recognized stage IIIA lung cancer with all degrees of mediastinal lymph node involvement. Current and future trials may modify these recommendations.
Multimodality therapy of some type appears to be preferable in all subsets of stage IIIA patients. However, because of the relative lack of consistent randomized trial data in this subset, the following evidence-based treatment guidelines lack compelling evidence in most scenarios.

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    • "Accordingly, the Authors concluded their analysis suggested a prognostic ( protective) role of adjuvant therapy in patients with positive PLC. As suggested by several guidelines on the strategy of care in NSCLC patients, the administration of platinum-based adjuvant therapy is clearly recommended in pathological Stage II-III (Grade 1A for ESMO [3] and ACCP [4]) and may be considered also in patients with resected Stage IB disease and a primary tumour >4 cm (Grade 2B for ESMO [5]). Therefore in such patients ( pStage II-III and selected cases of pStage IB), PLC findings represent a further negative prognostic factor that would probably influence the long-term outcome in such patients but not the strategy of care, considering that the adjuvant therapy is already recommended (as reported above). "

    Interactive Cardiovascular and Thoracic Surgery 07/2015; 21(1). DOI:10.1093/icvts/ivv137 · 1.16 Impact Factor
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    • "[3] "
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    ABSTRACT: Positive pleural lavage cytology (PLC) findings are considered to be predictive of a poor prognosis in patients with non-small-cell lung cancer (NSCLC). We investigated the clinical benefit of adjuvant chemotherapy for lung adenocarcinoma patients with positive PLC findings. We retrospectively reviewed the medical records of lung adenocarcinoma patients who underwent tumour resection and had positive PLC findings between January 2000 and December 2009. Fifty-three patients (4.8%) of 1114 patients with lung adenocarcinoma had positive PLC findings. The median follow-up period was 33.6 months. Adjuvant chemotherapy was administered to 24 patients (adjuvant chemotherapy group); 7, 8 and 9 patients had pathological Stage I, II and III, respectively . The surgery-alone group comprised 29 patients; 12, 8 and 9 patients had pathological Stage I, II and III, respectively. The 5-year recurrence-free survival (RFS) rates were 34.6 and 15.7% (P < 0.01) in adjuvant chemotherapy and surgery-alone groups, respectively. The rate of distant recurrence was significantly reduced in the adjuvant chemotherapy group (25.0 and 58.6%; P = 0.01). Even for Stage I cases, adjuvant chemotherapy tended to improve the 5-year RFS rate compared with surgery alone (60.1 and 29%; P = 0.11). Multivariate analysis for RFS revealed that adjuvant chemotherapy [hazard ratio (HR), 0.45; P = 0.03], tumour size >30 mm (HR, 2.23; P = 0.02) and lymph node metastasis (HR, 2.67; P < 0.01) were significant independent prognostic factors for recurrence. Adjuvant chemotherapy for lung adenocarcinoma patients with positive PLC findings significantly improved recurrence-free survival. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    Interactive Cardiovascular and Thoracic Surgery 04/2015; 21(1). DOI:10.1093/icvts/ivv098 · 1.16 Impact Factor
    • "The current standard of care for most patients with IIIA-N2 NSCLC patients is concurrent chemoradiotherapy [37]. However, long-term outcomes with this treatment are poor, due to a high rate of distant metastases and of local recurrence. "

    39th ESMO Congress (ESMO); 09/2014
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