Difficult Decisions in Thoracic Surgery

pp 111-117


Lobectomy After Induction Therapy for Stage IIIA NSCLC in the Presence of Persistent N2 Disease

  • Gaetano RoccoAffiliated withDepartment of Thoracic Surgery and Oncology, National Cancer Institute Pascale Foundation

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Involvement of mediastinal nodes by metastatic deposits from non-small cell lung cancer (NSCLC) is characterized by heterogeneous manifestations and diverse clinical scenarios (Table 11.1).1,2 For many of these N2 subsets the therapeutic options are well known and are accepted in the clinical practice.3 Patients with potentially resectable N2 disease detected preoperatively usually undergo induction treatment (chemotherapy and/or chemoradiotherapy) and subsequent resection if they show a clinical or pathological complete response.4 Conversely, patients with technically unresectable NSCLC and N2 disease are treated with definitive chemoradiotherapy.5 When N2 disease is discovered only at final pathology, an adjuvant chemoradiation therapeutic regimen is proposed.4,5