Pathological Status of Mediastinal Lymph Nodes after Preoperative Concurrent Chemoradiotherapy Determines Prognosis in Patients with Non-Small Cell Lung Cancer

Yasushi Shintani; Yasunobu Funakoshi; Masayoshi Inoue; Yukiyasu Takeuchi; Meinoshin Okumura; Hajime Maeda; Mitsunori Ohta,

doi:10.5761/atcs.oa.11.01811

Original Articles

Pathological Status of Mediastinal Lymph Nodes after Preoperative Concurrent Chemoradiotherapy Determines Prognosis in Patients with Non-Small Cell Lung Cancer

Yasushi Shintani, Yasunobu Funakoshi, Masayoshi Inoue, Yukiyasu Takeuchi, Meinoshin Okumura, Hajime Maeda, Mitsunori Ohta,

Author information

Yasushi Shintani
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Habikino, Osaka, Japan
Yasunobu Funakoshi
Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Osaka, Japan
Masayoshi Inoue
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Yukiyasu Takeuchi
Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Osaka, Japan
Meinoshin Okumura
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Hajime Maeda
Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Osaka, Japan
Mitsunori Ohta,
Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Habikino, Osaka, Japan

Keywords: nonsmall cell lung cancer, preoperative concurrent chemoradiotherapy, prognostic indicator

JOURNAL FREE ACCESS

2012 Volume 18 Issue 6 Pages 530-535

DOI https://doi.org/10.5761/atcs.oa.11.01811

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Abstract

Objectives: The benefits of preoperative chemoradiotherapy for advanced nonsmall cell lung cancer (NSCLC) remain controversial. To evaluate prognostic indicators of clinical N2 NSCLC patients treated with concurrent chemotherapy followed by pulmonary resection, we performed a retrospective study.
Methods: We retrospectively investigated 52 patients with pathologically proven N2 NSCLC who underwent concurrent chemoradiotherapy before pulmonary resection. Each received 2 cycles of cisplatin-vinca alkaloid-based chemotherapy every 4 weeks. Radiotherapy, directed at the tumor and mediastinal nodes, was started on day 2 at a median dose of 44 Gy. A thoracotomy was performed 6 to 8 weeks after completion of chemoradiotherapy.
Results: The overall 5-year survival rate for the 52 patients was 38%. Complete pathological response by the tumor was found in 11 (21%). Down-staging of nodal stage occurred in 29 patients, (56%) and overall survival was better in those with lower pathological N status. The 5-year survival rate was 58% for pathological N0-N1 disease and 0% for N2 disease. While the response to induction therapy by the primary tumor was correlated with postoperative nodal stage, multivariate analysis revealed postoperative nodal stage as an independent prognostic factor.
Conclusion: Pathological status of mediastinal lymph nodes in response to preoperative concurrent chemoradiotherapy determined prognosis in our patients.

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