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Surprised by stage III: unexpected N2 lymph node involvement found during surgery for early-stage NSCLC
Scott A Kono1, Michael Weyant, Wilbur Franklin
1Thoracic Oncology Program, University of Colorado Comprehensive Cancer Center, Denver, Colorado, USA.
Oncology (Williston Park, N.Y.)
|May 30, 2009
Summary
This patient with stage IIIA non-small cell lung cancer (NSCLC) will receive adjuvant cisplatin-based chemotherapy. Postoperative radiotherapy will be discussed, with potential eligibility for clinical trials based on treatment decisions.
Area of Science:
- Thoracic Oncology
- Medical Oncology
Background:
- Patient diagnosed with stage IIIA non-small cell lung cancer (NSCLC).
- EGFR-positive by IHC and FISH, but EGFR and KRAS wild type.
- Inadequate lymph node sampling (MLNS/MLND) in the perioperative setting.
Observation:
- Further extensive mediastinal examination post-surgery was considered but deemed unlikely to outweigh risks.
- The patient had PET-negative microscopic disease in Level 7 and 9 lymph nodes.
- Inadequate lymph node sampling precluded eligibility for the ECOG 1505 trial.
Findings:
- The recommended treatment is four cycles of adjuvant cisplatin-based chemotherapy.
- The patient is not eligible for adjuvant therapy in the ECOG 1505 trial due to inadequate lymph node sampling.
- Postoperative radiotherapy (PORT) will be discussed with the patient.
Implications:
- Adjuvant chemotherapy aims to reduce recurrence risk in early-stage NSCLC.
- The patient may be eligible for the RADIANT trial (erlotinib vs. placebo) if she declines PORT.
- Personalized treatment decisions in NSCLC require careful consideration of staging, molecular markers, and trial options.
