| Abstrakt: |
In locally advanced non-small-cell lung cancer, complete surgical excision is the goal. To achieve this, accurate clinical staging including minimally invasive surgical approaches is required. For stage II tumors, primary surgery is the optimum approach. Although postoperative adjuvant therapies including chemotherapy, radiation therapy, or both have been used, reported clinical trials have been disappointing in that little, if any, change in ultimate survival has been noted. A recent meta-analysis of such clinical trials confirms this finding. Once mediastinal lymph nodes are involved with tumor, the ultimate survival is poor. For this reason, preoperatively identified clinical “N2” disease has rarely been treated by primary surgery for cure. More recently, induction chemotherapy and chemoradiotherapy phase II and III trials have demonstrated an improved survival using this combined modality approach followed by surgery. Currently, a North American trial is comparing induction chemoradiotherapy followed by surgery with primary chemoradiotherapy for patients with stage IIIA (N2) disease. Once tumors are clinically staged IIIB (T4 or N3 disease), the results of surgical therapy are quite disappointing. However, certain select T4 NO tumors have been treated by surgery with reasonable 5-year survivals when complete resection has been accomplished. When contralateral mediastinal lymph nodes are involved with tumor (N3), primary surgery has rarely been offered for treatment. There has been one phase II trial of chemoradiation plus surgery in this stage of disease with mildly encouraging results. On occasion, it is worthwhile to use surgical excision for resectable primary non-small-cell lung cancer even when solitary sites of metastases are present, for example, brain, lung, and possibly adrenal. Surgery remains an important part of treatment for patients with locally advanced lung cancer. |
