A prospective phase II study of a new treatment protocol for NSCLC combined with preoperative mediastinoscopy and chemotherapy.

BACKGROUND

We have developed a new multimodal treatment protocol combined with video-assisted mediastinoscopy (VAM) and chemotherapy.

METHODS

Forty-four pN2 non-small cell lung cancer (NSCLC) cases were selected from the surgically treated groups and the prognoses were compared between October 1998 and December 2004. Patients negative for nodes on examination by VAM (VAM-negative: group 2) underwent thoracotomy, and those positive for nodes (VAM-positive) received induction chemotherapy. After chemotherapy, only patients who met the surgical criteria underwent thoracotomy (group 3), and the remaining cases were allocated to radiotherapy (group 4) or best supportive care. When none of the VAM criteria were met (group 1), thoracotomy was performed without VAM.

RESULTS

The overall 3- and 5-year survival rates were 42.1 % and 28.0 %. The survival rates in groups 2 and 3 were almost the same ( P = 0.5392), even though there were significantly more patients with multiple N2 stations in group 3 ( P = 0.0088).

CONCLUSIONS

Preoperative detection of lymph node metastasis by VAM makes use of the benefits of surgical intervention, and adjuvant therapies improve the survival of NSCLC patients with N2 disease.