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According to results recently presented at the 39th annual meeting of the American Society of Clinical Oncology, surgery plus radiation and chemotherapy improves survival compared to radiation and chemotherapy alone in a specific subset of patients with non-small cell lung cancer (NSCLC).

Lung cancer is the leading cause of cancer deaths in the United States. Non-small cell lung cancer refers to the type of cell within the lung that the cancer originated. Stage IIIA NSCLC means that cancer has not spread outside the lung but has invaded local lymph nodes. Patients with stage IIIA N2 NSCLC have cancer that has spread to the mediastinal (middle of the chest) lymph nodes. Surgical removal of mediastinal lymph nodes is difficult and these patients do not have optimal long-term outcomes. Clinical trials have been ongoing to address the issue of multimodality treatment including the effectiveness of surgery in stage IIIA N2 NSCLC.

Recently, researchers from Loyola University conducted a clinical trial evaluating the effectiveness of surgery in patients with stage IIIA N2 NSCLC. In this trial, nearly 400 patients were divided into two groups: those who were treated with surgery, chemotherapy and radiation and those who were treated only with chemotherapy and radiation. Outcomes of the two groups were then directly compared. All patients initially received chemotherapy plus daily radiation therapy. Patients in the surgery group then underwent the surgical removal of their cancer if their disease had not progressed during initial treatment. Following surgery, they received further chemotherapy. The other group of patients continued to be treated with uninterrupted radiation therapy and further chemotherapy.

Three years following treatment, nearly 30% of patients treated with surgery did not experience cancer progression, compared to 19% of patients not treated with surgery. Overall survival at three years was 38% for patients treated with surgery, compared to 33% for patients not treated with surgery. There were more severe side effects reported in the group of patients treated with chemotherapy and radiation only; however, there were more treatment-related deaths in the group of patients undergoing surgery.

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The researchers concluded that surgery, in addition to chemotherapy and radiation, appears to improve survival in patients with stage IIIA N2 NSCLC. However, these researchers stress the importance of a multidisciplinary approach with a team of physicians including a medical oncologist, radiation oncologist and thoracic surgeon in order to provide optimal patient selection and care with this treatment regimen. Patients with stage IIIA N2 NSCLC may wish to speak with their physician about the risks and benefits of the integration of surgery into their treatment regimen.

Reference: Albain K, Scott C, Rush V, et al. Phase III comparison of concurrent chemotherapy plus radiotherapy (CT/RT) and CT/RT followed by surgical resection for stage IIIA (pN2) non-small cell lung cancer (NSCLC): Initial results from intergroup trial 0139 (RTOG 93-09). Proceedings from the 39th annual meeting of the American Society of Clinical Oncology. May 2003. Abstract #2497.

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