Patterns of relapse of N2 nonsmall-cell lung carcinoma patients treated with preoperative chemotherapy Should prophylactic cranial irradiation be reconsidered?

BACKGROUND. Although it induces a relevant reduction in the risk of both Vi sceral metastases and locoregional recurrences, the combination of chemothe rapy and surgery only marginally improves the survival of patients with Sta ge IIIA(N2) (International Union Against Cancer staging and classification system) nonsmall-cell lung carcinoma (NSCLC). The purpose of the current st udy was to analyze the patterns of relapse in these patients. METHODS. In this study, the authors compared the patterns of relapse in 81 patients with clinically detectable N2 NSCLC who had been treated with preo perative chemotherapy with the relapse patterns of 186 comparable patients who had been treated with primary surgery. Clinically detectable N2 (cN2) d enotes mediastinal lymph node enlargement on computed tomography scan, whic h then is confirmed by mediastinoscopy. RESULTS. Overall 20% of patients developed a locoregional recurrence. Chemo therapy decreased the risk of visceral metastasis as 28% of the patients pr eoperatively treated and 38% of those not treated with preoperative chemoth erapy presented a visceral metastasis (P < 0.05). Preoperative chemotherapy and adenocarcinoma subtypes were associated with a higher rate of brain me tastasis (P < 0.05). Thirty-two percent of the patients treated preoperativ ely and 18% of those not treated with preoperative chemotherapy presented a brain metastasis (P < 0.05), which was isolated in 22% and 11% of the pati ents, respectively (P < 0.05). CONCLUSION. The current study found that preoperative chemotherapy for cN2 decreases the risk of visceral metastasis but is associated with a high rat e of isolated brain metastases. Prophylactic cranial irradiation may need t o be reinvestigated in clinical trials, especially in patients who present with an adenocarcinoma. (C) 2001 American Cancer Society.