The multimodal management of locally advanced N2 non-small cell lung cancer: is there a role for surgical resection? A single institution’s experience

Background The management of operable locally advanced N2 non-small cell lung cancer (NSCLC) is a controversial topic. Concurrent chemoradiation (CT-RT) is considered the standard of care for inoperable or unresectable patients, but the role of trimodality treatment remains controversial. We present our institution’s experience with the management of stage III (N2) NSCLC patients, analyzing whether the addition of surgery improves survival when compared with definitive CT-RT alone. Methods From 1996 to 2006, 72 N2 NSCLC patients were treated. Thirty-four patients received cisplatin-based induction chemotherapy, followed by paclitaxel-cisplatin CT-RT, and 38 patients underwent surgery preceded by induction and/or followed by adjuvant therapy. Survival curves were estimated by Kaplan–Meier analysis, and the differences were assessed with the log-rank test. Results Most of the patients (87 %) were men. The median age was 59 years. A statistically significant association between T3–T4c and definitive CT-RT as well as between T1–T2c and surgery was noted ( p