Introduction Multimodality treatment, with surgery in addition to chemo-radiotherapy, may be considered for patients with stage IIIA-N2 non-small cell lung cancer (NSCLC) that are medically operable, have single station N2 disease and a primary tumour that is resectable with a lobectomy. This strategy has been demonstrated to improve survival compared to chemo-radiotherapy without surgery.
In comparison to definitive treatment with concurrent chemo-radiotherapy, neoadjuvant treatment uses lower radiotherapy doses and fewer chemotherapy cycles. Patients that receive neoadjuvant treatment but do not proceed to surgery are at risk of receiving suboptimal oncological treatment. Careful patient selection is key to optimising outcomes in this cohort.
We have audited the treatment outcomes for patients with stage IIIA-N2 NSCLC.
Methods Patients diagnosed with lung cancer in 2016–2017 were identified from local electronic health records. Those with pathologically confirmed NSCLC, radiological stage IIIA-N2, and performance status 0–2 were included.
Results 47 patients met the inclusion criteria. 26 patients (55%) commenced curative treatment, none of whom had a Pancoast tumour. Patient demographics and the proportion of patients completing their planned treatment are shown in figure 1.
13 of 15 patients (87%) planned for curative treatment that included surgery completed their planned treatment. Those that did not had performance status ≤1 and were of comparable age to those that completed surgical treatment (± 0.5 SD of mean age).
9 of 11 patients (82%) that were planned for curative non-surgical treatment completed their planned treatment. Those that did not complete treatment were performance status 2 and one patient was elderly (>80 years).
Conclusion The demographics of the treatment groups were as expected, with a younger age and more favourable performance status found in those planning to undergo surgical treatment. The majority of patients completed their planned curative treatment, including those planned for surgery. Assessing the proportion of patients that complete planned treatment at a local level is important to inform decision making within the MDT.
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