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Eur J Cardiothorac Surg 1999;15:608-614
© 1999 Elsevier Science NL

Result of induction chemotherapy followed by surgery in patients with stage IIIA N2 NSCLC: importance of pre-treatment mediastinoscopy

^a Department of Thoracic Surgery, University Hospital Gasthuisberg, Catholic University, Heretraat 49, B-3000 Leuven, Belgium
^b Department of Pulmonology, University Hospital Gasthuisberg, Catholic University, Heretraat 49, B-3000 Leuven, Belgium

Received 12 October 1998; received in revised form 27 January 1999; accepted 10 February 1999.

Corresponding author. Tel.: +32-16346820; fax: +32-16346821
e-mail: paul.deleyn{at}uz.kuleuven.ac.be

Objective: Data from the literature indicate that chemotherapy prior to resection may improve the results. However, only few and conflicting data are reported regarding the correlation between downstaging of mediastinal nodes and outcome. The aim of this study was to look at the correlation between downstaging, survival and pre-treatment staging. Material and methods: Between March 1995 and August 1998, 46 consecutive patients with pathology proven N2 disease were treated with three cycles of vindesine-ifosfamide-platinum (VIP). All patients underwent a rigorously performed cervical mediastinoscopy. Patients with at least partial response (n=26) were surgically explored. Results: The clinical response rate to chemotherapy was 57% (26 patients). Resection was complete in 23 patients (88.5%). Pneumonectomy was performed in 16 patients. In 11 patients (42.9%) the mediastinal nodes (which were positive at mediastinoscopy) had become negative (downstaging group). The projected 2-year survival of resected patients is 41%. Patients with downstaging of nodes had no better survival compared to patients with no downstaging. Patients with involved subcarinal nodes at mediastinoscopy and patients with involvement of more than one level had a worse survival. Conclusion: Surgery in N2-patients responsive to induction chemotherapy resulted in a high complete resectability rate. Findings at pre-treatment mediastinoscopy proved to be the most important prognostic factor.

Key Words: Carcinoma • Non-small cell lung • Combined modality treatment • Induction chemotherapy • Lung surgery • N2-disease

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