Result of induction chemotherapy followed by surgery in patients with stage IIIA N2NSCLC: importance of pre-treatment mediastinoscopy

Objective: Data from the literature indicate that chemotherapy prior to res ection 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: Betw een March 1995 and August 1998, 46 consecutive patients with pathology prov en N2 disease were treated with three cycles of vindesine-ifosfamide-platin um (VIP). All patients underwent a rigorously performed cervical mediastino scopy. Patients with at least partial response (n = 26) were surgically exp lored. Results: The clinical response rate to chemotherapy was 57% (26 pati ents). Resection was complete in 23 patients (88.5%). Pneumonectomy was per formed 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 do wnstaging of nodes had no better survival compared to patients with no down staging. Patients with involved subcarinal nodes at mediastinoscopy and pat ients with involvement of more than one level had a worse survival. Conclus ion: Surgery in N2-patients responsive to induction chemotherapy resulted i n a high complete resectability rate. Findings at pre-treatment mediastinos copy proved to be the most important prognostic factor. (C) 1999 Elsevier S cience B.V. All rights reserved.