Lung Cancer Clinical Trial
Official title:
Treatment Strategy of Surgical Resection With Sequential Adjuvant Chemotherapy and Radiotherapy for Patients With Stage IIIA Non-small Cell Lung Cancer and N2 Disease Only in the Subaortic or Paraaortic Level, or Both
The purpose of this study is to identify the treatment outcomes of surgical resection with sequential adjuvant chemotherapy and radiotherapy in patients with stage IIIA non-small cell lung cancer and N2 disease at only the sub- or para-aortic level.
Stage IIIA non-small cell lung cancer (NSCLC) is a very heterogeneous disease and current
treatment guidelines recommend concurrent chemoradiation therapy or combined neoadjuvant
chemotherapy, surgical resection, and sequential adjuvant therapy. When incidental N2
disease is found despite thorough preoperative staging, adjuvant platinum-based chemotherapy
with or without adjuvant radiotherapy is recommended.
Although guidelines suggest preoperative mediastinal staging with endobronchial
ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), this method does not allow
approach of the sub- or para-aortic lymph nodes. Therefore, patients with suspected stage
IIIA NSCLC and N2 disease only at the sub- or para-aortic level should undergo several
processes if combined neoadjuvant chemotherapy and surgical resection is planned. First,
video-assisted thoracoscopic surgery (VATS) should be performed to verify whether the sub-
or para-aortic lymph nodes are involved. If a frozen-section biopsy reveals no malignant
tumor involvement in the sub- and para-aortic lymph nodes, the affected lung can be
resected. If there is sub- or para-aortic lymph node involvement, further neoadjuvant
chemotherapy is required before surgical resection and adjuvant therapy.
Studies have shown that stage IIIA NSCLC with only sub- or para-aortic lymph node
involvement has better outcomes than other stage IIIA NSCLC. Moreover, the five-year
survival of patients with stage IIIA NSCLC with only sub- or para-aortic lymph node
involvement is similar to that with stage II NSCLC. However, those studies were
retrospective with relatively small sample sizes. Therefore, we evaluated the outcomes of
combined surgical resection with adjuvant chemotherapy and radiotherapy in patients with
stage IIIA NSCLC and N2 disease at only the sub- or para-aortic level.
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Observational Model: Cohort, Time Perspective: Prospective
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