Clinical predictors of N2 disease in the setting of a negative computed tomographic scan in patients with lung cancer

Abstract

Preoperative cervical mediastinoscopy should be considered in patients in whom computed tomography is negative for lung cancer and who have some pathologic N2 predictive factors.

Impact of Incidental Irradiation on Clinically Uninvolved Nodal Regions in Patients With Advanced Non-Small-Cell Lung Cancer Treated With Involved-Field Radiation Therapy: Does Incidental Irradiation Contribute to the Low Incidence of Elective Nodal Failure?

“…On the other hand, the argument against the omission of ENI may be summarized as follows (17)(18)(19). (1) The incidence of pathologically proven nodal metastasis even in stage I NSCLC may be as high as 26% (20), and the incidence of lymphatic invasion or metastasis rises with increasing tumor size (21). (2) Therefore, many patients would die from distant metastasis or local failure, and ENF may not be often observed.…”

Involved-Field Radiation Therapy (IF-RT) for Non-Small Cell Lung Cancer (NSCLC)

“…On the other hand, the argument against the omission of ENI may be summarized as follows [13][14][15] . 1) The incidence of pathologically proven nodal metastasis even in stage I NSCLC may be as high as 26% 16) , and the incidence of lymphatic invasion or metastasis rises with increasing tumor size 17) . 2) Therefore many patients would die from distant metastasis or local failure, and ENF may not be often observed.…”

Stage N2/IIIA Non Small Cell Lung Cancer: An Evidence-Based Review

“…When the primary is greater than 2cm and the CEA level more than 5.0ng/ml then the chance of N2 disease is 40% [6][7][8]. Computed tomography (CT) scanning is the preliminary modality used today with CT-PET (positron emission tomography) fusion being more accurate in determining the likelihood of mediastinal disease.…”

“…Other adverse factors are older age, adenocarcinoma, primary tumor stage-T3/4, poorly differentiated histology, extracapsular spread, incomplete resection and extent of resection (lobectomy vs. pneumonectomy) [7,[41][42][43]. Multilevel disease is associated with a uniformly poor prognosis in the order of 5 -15% five year survival and at this time surgery as the sole therapy is not recommended [44,45].…”