Stage IIIA NSCLC with limited N2 disease: Ιnduction chemotherapy and reseption or surgical treatment and adjuvant chemotherapy?

摘要

Lung cancer constitutes the most frequent cause of death from malignancyin humans with 160.000 deaths registered annually1 in the USA andmore than one million worldwide2. Approximately 85% of the annually diagnosedcases relate with NSCLC with low overall 5-year survival rate (<15%).Thirty percent of the patients with NSCLC and 10% of the total number ofpatients with lung cancer estimated with locally advanced disease of stageIIIA due to the existence of N2 disease.This heterogeneous group of patients is located in the marginal areabetween the operable stages I and II and the inoperable stage IIIB, and it ischaracterized from 5-year survival rates that vary from 13-23%3. The therapeuticoptions for the management of these patients were always a subjectof controversy4. With the term “limited N2 disease” (minimal N2 disease) weindicate the patients with lung cancer and metastasis in only one groupof unilaterally mediastinal lymph nodes without rupture of their capsuleand extension in the surrounding soft tissues. These patients present thehighest survival rate after complete surgical excision of the disease, a factthat is clearly defined from the term “surgical N2 NSCLC disease”5.