Introduction The optimal management of lung cancer patients with metastatic involvement of the ipsilateral mediastinum (N2 disease) remains controversial. Randomised controlled trials have failed to demonstrate superiority of one bimodality strategy over another (chemotherapy plus surgery versus chemotherapy plus radiotherapy). There is little knowledge of real world experience of the uptake of different treatment regimens and the corresponding survival outcomes. Data collected via the National Lung Cancer Audit (NLCA) and linked for the first time to the national radiotherapy dataset (RTDS) allow us to describe the treatment patterns and outcomes of patients with N2 disease in England.

Methods Patients diagnosed with stage T1–3, N2, M0 non-small cell lung cancer between 1 st January 2015 and 31 st December 2015 were identified. The dose and schedule of radiotherapy treatments described in the RTDS were used to determine if the radiotherapy was given with radical or palliative intent. The proportion of patients alive at the time of data analysis (9–21 months from diagnosis) were calculated according to treatment category.

Results 2305 of 36 025 (6.4%) patients met the inclusion criteria. The proportion of patients receiving each treatment modality with corresponding survival are shown in Table 1. 243 (10.5%) patients received surgery and chemotherapy, 230 (10%) patients received radical radiotherapy and chemotherapy, 618 (26.8%) palliative radiotherapy or palliative chemotherapy and 802 (34.8%) received best supportive care. The proportion of patients alive was 74.4% in patients receiving surgery; 63.2% for patients receiving radical radiotherapy, 41.8% for palliative chemotherapy/radiotherapy and 23.1% for supportive care.

Conclusions The commonest curative intent treatments are bimodality treatment (chemotherapy combined with either surgery or radical radiotherapy), however only one fifth of patients received this. The majority of patient still receive palliative treatment only. Survival is higher in patients who receive surgery as part of their treatment however we are unable to exclude selection bias as the reason for this. Further risk adjustment analysis will be performed to assess this.