Induction therapy for non-small cell lung cancer with involved mediastinal nodes in multiple stations

BACKGROUND: Metastasis to multiple stations of mediastinal nodes is associated with a poor prognosis. OBJECTIVE:: We prospectively examined the efficacy of induction therapy plus surgery in patients with non-small cell lung cancer and metastases at multiple stations of mediastinal (N2) lymph nodes. METHODS: Among the 1,085 patients who underwent surgery for primary non-small cell lung carcinoma from 1985 to 1997, those with clinical N2 disease of involved multiple stations, defined as bulky, mediastinal, lymph node metastases on CT scans, received induction therapy, consisting of cisplatin-based chemotherapy and radiation of 40 Gy. RESULTS: Of the 88 eligible patients entered into the study, 51 (58%) had multiple stations of N2 nodes affected preoperatively, as demonstrated by pathologic examination. Neither operative mortality nor fatal, treatment-related complications occurred during hospitalization. Patients who underwent complete resection had significantly longer survivals than did those who underwent incomplete resection (p = 0. 001). Among patients who underwent complete resection, the survival rate for patients with pathologically downstaged disease was significantly higher than that for patients whose disease was not downstaged (p = 0.009). Among patients with multiple stations of pN2 nodes involved who had undergone complete resection, those who received induction therapy for bulky N2 disease had a significantly better prognosis than did those undergoing surgery alone for nonbulky N2 disease (p = 0.03). CONCLUSIONS: Induction therapy prolonged the survival of patients with non-small cell lung cancer and mediastinal nodes involved at multiple stations. Survival was better when complete resection and downstaging of the disease were achieved after induction therapy.