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Fontaine et al (2011)

Fontaine et al (2011). By definition unsuspected pN2 This study does not address; Management of enlarged pN2 Role of induction chemo or chemo/RT But it might address; Management of normal size pN2 known pre-op. Fontaine et al(2011). No. pN2 due to PET/CT?

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Fontaine et al (2011)

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  1. Fontaine et al (2011) • By definition unsuspected pN2 • This study does not address; • Management of enlarged pN2 • Role of induction chemo or chemo/RT • But it might address; • Management of normal size pN2 known pre-op

  2. Fontaine et al(2011) • No. pN2 due to PET/CT? • Normal size nodes before PET/CT era • Stage migration? • Does this analysis tell us how EBUS/EUS/ • mediastinoscopy proven pN2 based on • SUV (not size) will fare?

  3. Fontaine et al (2011) • Can an observational study alone determine best Rx? • Prognostic factors not predictive of outcome benefit from Rx • But can identify increased risk • eg pneumonectomy

  4. EORTC 08941(Van Meerbeeck 2007) • “Unresectable” pN2 • Before PET/CT • >80% mediastinoscopy • Induction chemo 3 cycles • platinum/gem platinum/taxol • Responders randomised to surgery v XRT

  5. EORTC 08941 • 1994-2002 • N = 579 • 61% response rate (CR, PR, MR) • 57% randomised • 52% treated

  6. EORTC 08941Surgery • 14% open and close • 50% R0 • 4% 30 day mortality (pneumonectomy 7%) • 40% post op XRT

  7. EORTC 08941XRT • 60-62.5 Gray in 30-32 # • Prophylactic nodal XRT • 86% commenced RT within 10 weeks of cycle 3 day 1 chemo • Suboptimal overall Rx time • 1 pneumonitis death (0.7%)

  8. EORTC 08941

  9. INTERGROUP 0139(Albain 2009) • T1-3 pN2 • Cisplatin/etoposide 2 cycles • Concurrent XRT (45Gy/25#) • Randomisation; • Surgery+ adj chemo v concurrent chemo XRT (61Gy) • OS and PFS

  10. INTERGROUP 0139 • 1994-2001 n=429 (target 612) • Randomisation “up front” • Intention to treat analysis • 8% ineligible • Unplanned subgroup analysis; lobectomy v pneumonectomy

  11. Intergroup 0139Surgery • 75% thoracotomy • 5.5% open and close • 88% complete resection • 6% 30 day mortality (10% Rx related) • 26% pneumonectomy mortality • 1% lobectomy mortality • 68% completed adj chemo

  12. SOCCARNSCLC Stage III PS 0 - 1 % CON SEQ n 67 59 median 27.4 m 18.6 m 1 year 73.1% 83.1% 2 year 54% 42% 3 year 38% 27% 5 year 33.6% NR Local PD 10% 22% Con Seq Months

  13. Tx N2 M0 Chemo/XRT (2008-2011) (n=85)

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