Candidates for Intensive Local Treatment in cIIIA-N2 Non-Small Cell Lung Cancer: Deciphering the Heterogeneity

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• 作者：Hidehito Horinouchi ; MD<sup>&lowast ; sup><sup> ; sup><sup>&dagger ; sup><sup> ; sup><sup>hhorinou@ncc.go.jp" class="auth_mail" title="E-mail the corresponding authorsup> ; Yasushi Goto ; MD ; PhD<sup>&lowast ; sup> ; Shintaro Kanda ; MD ; PhD<sup>&lowast ; sup> ; Yutaka Fujiwara ; MD ; PhD<sup>&lowast ; sup> ; Hiroshi Nokihara ; MD ; PhD<sup>&lowast ; sup> ; Noboru Yamamoto ; MD ; PhD<sup>&lowast ; sup> ; Minako Sumi ; MD ; PhD<sup>&Dagger ; sup> ; Tomohide Tamura ; MD<sup>&lowast ; sup> ; Yuichiro Ohe ; MD ; PhD<sup>&lowast ; sup><sup> ; sup><sup>&dagger ; sup>
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2016
• 出版时间：1 January 2016
• 年：2016
• 卷：94
• 期：1
• 页码：155-162
• 全文大小：513 K

文摘

The purpose of this study was to refine the heterogeneous clinical stage IIIA non-small cell lung cancer (NSCLC) with N2 nodes status (cIIIA-N2) by clinicopathological characteristics before treatment.

sSec_2">Methods and Materials

spara0015">We analyzed data of consecutive patients with cIIIA-N2 NSCLC diagnosed between 1997 and 2010 and treated by chemoradiation therapy (CRT). The appearance of the mediastinal lymph nodes (MLNs) was classified into discrete or infiltrative according to the criteria proposed by the American College of Chest Physicians. 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).

sSec_3">Results

spara0020">A total of 148 patients with cIIIA-N2 NSCLC was treated by CRT. The patient characteristics were as follows: males: 118; females: 30; median age: 62 years; appearance of the involved MLNs: 85 discrete, 63 infiltrative; extent of MLNI: 82 limited, 66 extensive; histology: 36 squamous, 112 nonsquamous. 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 (24.6% discrete, 18.9% infiltrative); extent of MLNI (25.9 limited, 17.9% extensive).

sSec_4">Conclusions

spara0025">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.