In reply to Hastings and Iganej

摘要

We thank Drs Hastings and Iganej for their interest and appreciation of the American College of Radiology Appropri-ateness-Criteria for induction and adjuvant therapy for stage N2 non-small cell lung cancer (1,2). Their reference to the update of Roth et al (3) will be incorporated into the next version of the Appropriateness Criteria. It is not unusual for the results of randomized studies to be modified with longer follow-up, and in this case the difference between the arms has decreased. It nevertheless remains substantial for all patients (3-year overall survival 43% vs 19%) and is particularly large for patients who had a complete resection (59% vs 24%). It is unclear whether this update would have any significant impact on the meta-analysis (4) showing a benefit to induction chemotherapy. An updated meta-analysis that included 6 additional randomized trials confirmed this as well (5). Our overall recommendation is not, therefore, affected. The literature continues to show that initial surgery for N2 non-small cell lung cancer is not the optimal approach; multiple randomized studies, as indicated in our review, demonstrate improved outcomes with neoadjuvant treatment, either chemotherapy or chemoradiation.