Candidates for intensive local treatment in cIIIA-N2 non-small cell lung cancer: deciphering the heterogeneity
Menée à partir de données portant sur 148 patients atteints d'un cancer du poumon non à petites cellules de stade cIIIA-N2 diagnostiqué entre 1997 et 2010 puis traité par chimioradiothérapie (âge médian : 62 ans ; 118 hommes et 30 femmes), cette étude évalue la survie sans progression et la survie globale en fonction des caractéristiques avant traitement de l'envahissement des ganglions lymphatiques du médiastin
Objective : To refine the heterogeneous clinical stage IIIA non-small cell lung cancer (NSCLC) with N2 nodes status (cIIIA-N2) by clinico-pathological characteristics before treatment.
Methods and materials : We analyzed the data of consecutive patients with cIIIA-N2 NSCLC diagnosed between 1997 and 2010 and treated by chemoradiotherapy (CRT). The appearance of the mediastinal lymph nodes (MLNs) was classified into discrete (D) or infiltrative (I) according to the criteria proposed by the ACCP. In addition, the extent of MLN involvement (MLNI) was classified as limited (close to the primary tumor) or extensive (including upper MLNI in the case of tumors in the lower lobes and vice versa).
Results : A total of 148 patients with cIIIA-N2 NSCLC was treated by CRT. The patient characteristics was as follows; male/female, 118/30; median age, 62 years; appearance of the involved MLNs (D/I), 85/63; extent of MLNI (limited [L] /extensive [E]), 82/66; histology (squamous [sq] /non-squamous [non-sq]), 36/112. The median progression-free survival (PFS) and median overall survival (OS) in the entire subject population were 9.9 and 34.7 months, respectively. A discrete appearance of the involved MLNs and a limited extent of MLNI contributed significantly to a better PFS and OS. The percentages of cases with relapses within the irradiated field classified according to the characteristics of the MLNs were as follows; appearance of the MLNs (D/I), 24.6/18.9%; extent of MLNI (L/E), 25.9/17.9%.
Conclusions : Those with a discrete appearance of the involved MLNs and a limited extent of MLNI at diagnosis could show relatively more favorable outcomes and could be candidates for multimodality therapy.
International Journal of Radiation Oncology • Biology • Physics , résumé, 2014