Surgical Treatment of Patients With N2 Disease

Patients with stage IIIA (N2) non-small cell lung cancer constitute a significant proportion of the total lung cancer population. Mediastinoscopy plays an important role in identifying and staging such patients. Complete surgical resection yields an approximate 5-year survival rate of 30% in patients with microscopic lower mediastinal nodal metastases but is no longer standard treatment for most patients with N2 disease. Induction cisplatin-based chemotherapy or chemoradiotherapy followed by surgical resection has significantly improved long-term outcome with acceptable morbidity and mortality compared with historical experience with surgical resection or radiation alone. An ongoing intergroup clinical trial will define whether induction chemoradiotherapy followed by surgical resection is superior to chemotherapy and higher dose radiation without resection.