Results of Surgical Treatment of Stage III Lung Cancer Invading the Mediastinum

Burt, Michael; Pomerantz, Arthur H.; Bains, Manjit S.; McCormack, Patricia; Kaiser, Larry R.; Hilaris, Basil S.; Martini, Nael

doi:10.1016/s0039-6109(16)44337-9

Cited by 95 publications

(32 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…• Survival following resection of T4 tumors that invade the superior vena cava and other great vessels has historically been very poor. Burt et al [54] reported no survivors in a series of 18 patients with extended lung resections involving the vena cava from MSKCC. Tsuchiya [55] reported similar poor results with only two survivors out of 101 resections from Japan.…”

Section: T4 Tumorsmentioning

confidence: 99%

Management of Locally Advanced Non Small Cell Lung Cancer from a Surgical Perspective

Roy

Donington

2007

Curr. Treat. Options in Oncol.

View full text Add to dashboard Cite

Stage III, locally advanced NSCLC, represents an incredibly heterogeneous group of patients. Optimal therapy for this group is controversial and the role of surgery is not clearly defined. There have been several randomized trials over the past three decades that have helped to guide our decision-making. In patients with T3N1 tumors, surgery is the primary treatment and there is now evidence for the use of adjuvant chemotherapy. Consensus has shown that the majority of IIIB tumors are not amenable to resection. Exceptions to this are selective T4 tumors by virtue of a satellite nodule or those with isolated invasion of the spine, superior sulcus, carina or vena cava. Such tumors require technically difficult resections and are reserved for patients with excellent performance status and no evidence of N2 disease. Patients with N2 disease represent the largest proportion of patients with stage III disease. There is an increasing understanding of the importance of multi-modality therapy for N2 disease, but the exact role and timing of chemotherapy, radiation and surgery remains unclear. The role of surgery is determined by the bulk of the mediastinal node involvement. Clearly, not all N2 disease is the same. Patients with micometastatic disease and single station nodal involvement have the greatest chance for cure and surgery has a significant role in their treatment. In addition, the ability to sterilize mediastinal lymph nodes with induction therapy correlates strongly with survival. However, the ideal form and timing of induction therapy has yet to be determined. Bulky multi-station disease is frequently not amenable to surgery and is best approached with definitive chemotherapy and radiation.

show abstract

Section: T4 Tumorsmentioning

confidence: 99%

Management of Locally Advanced Non Small Cell Lung Cancer from a Surgical Perspective

Roy

Donington

2007

Curr. Treat. Options in Oncol.

View full text Add to dashboard Cite

show abstract

“…Glazer et al [14] have studied 80 patients with indeterminate mediastinal invasion by CT scan, and they reported 60% were completely resectable, 22% with focal mediastinal invasion were still technically resectable and only 18% patients were truly unresectable. Resection of T4 lesions invading the myocardium, aorta, esophagus, or vertebral body still remains less successful and carries poorer prognosis [7,8,26].…”

Section: T-statusmentioning

confidence: 99%

“…Pleural effusion could be either benign or malignant [9,27] that might affect treatment modalities. Therefore, it is important to perform preoperative pleural effusion analysis for NSCLC patients [26].…”

Section: T-statusmentioning

confidence: 99%

“…Although metastatic disease to hilar LN (N1) does not affect resectability, bulky N2 disease indeed exhibited far worsened 5-year survival rate [1,2]. Patients with T3 NSCLC are associated with high incidence of mediastinal LN metastases (N2) [1,26]. The only reliable CT sign of nodal metastasis is LN enlargement (short-axis diameter >1 cm), but reactive hyperplasia may also appear present as LN enlargement [1,6,20,25].…”

Section: N-statusmentioning

confidence: 99%

See 1 more Smart Citation

CT and MRI for staging of locally advanced non-small cell lung cancer

Chern

Chang

2003

Lung Cancer

View full text Add to dashboard Cite

“…Patients with T3N0 tumors have a higher cure rate than those with N2 nodal disease [2,3]. Moreover, the extent of nodal N2 disease (clinically detectable versus microscopic disease) affects the clinical outcome [22]. Usually, only patients with clinically apparent N2 disease, except those with bulky disease, were included in induction chemotherapy trials.…”

Section: Induction Chemotherapymentioning

confidence: 99%

Adjuvant and Induction Chemotherapies in Non-Small-Cell Lung Cancer

Pirker¹,

Zöchbauer²,

Krajnik³

et al. 1996

Oncol Res Treat

View full text Add to dashboard Cite

Many patients with completely resected non-small-cell lung cancer relapse locally or systemically. Besides better local control, therefore, effective systemic therapies are required in order to improve the outcome. Previous adjuvant chemotherapy did result in improved survival in some trials but not in others. A recent meta-analysis of these trials revealed that postoperative cisplatin-based chemotherapy leads to a 13% reduction in the risk of death as compared to surgery alone, which is equivalent to an absolute survival benefit of 5% at 5 years. The availability of new drugs and improved supportive care have resulted in renewed interest in postoperative adjuvant chemotherapy. Thus adjuvant chemotherapy is currently re-evaluated in clinical trials that include more active protocols and better antiemetics in order to improve patient compliance. Many phase II trials of induction chemotherapy with or without radiation therapy suggested an improved clinical outcome in patients with locally advanced non-small-cell lung cancer. More recently, three small randomized trials demonstrated a survival benefit for induction chemotherapy followed by surgery as compared to surgery alone. Thus induction therapy protocols should be further evaluated in clinical trials in order to determine the optimal chemotherapy protocols and the optimal local control (surgery or radiotherapy or both) in patients with locally advanced disease.

show abstract

Results of Surgical Treatment of Stage III Lung Cancer Invading the Mediastinum

Cited by 95 publications

References 12 publications

Management of Locally Advanced Non Small Cell Lung Cancer from a Surgical Perspective

Management of Locally Advanced Non Small Cell Lung Cancer from a Surgical Perspective

CT and MRI for staging of locally advanced non-small cell lung cancer

Adjuvant and Induction Chemotherapies in Non-Small-Cell Lung Cancer

Contact Info

Product

Resources

About