Prospective phase II trial of preresection thoracoscopic mediastinal restaging after neoadjuvant therapy for IIIA (N2) non-small cell lung cancer: Results of CALGB Protocol 39803

详细信息    查看全文

• 作者：Michael T. Jaklitsch ; MD^a ; ^{mjaklitsch@partners.org} ; Lin Gu ; MS^b ; Todd Demmy ; MD^c ; David H. Harpole ; MD^d ; Thomas A. D'Amico ; MD^d ; Robert J. McKenna ; MD^e ; Mark J. Krasna ; MD^f ; Leslie J. Kohman ; MD^g ; Scott J. Swanson ; MD^a ; Malcolm M. DeCamp ; MD^h ; Xiaofei Wang ; PhD^b ; Susan Barry ; BS^b ; David J. Sugarbaker ; MD^a ; CALGB Thoracic Surgeons
• 关键词：10 ; 28
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2013
• 出版时间：July, 2013
• 年：2013
• 卷：146
• 期：1
• 页码：9-16
• 全文大小：127 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferencesversion=""1.0"" encoding=""UTF-8""?>

Objective

Accurate pathologic restaging of N2 stations after neoadjuvant therapy in stage IIIA (N2) non-small cell lung cancer is needed.

Methods

A prospective multi-institutional trial was designed to judge the feasibility of videothoracoscopy to restage the ipsilateral nodes in mediastinoscopy-proven stage IIIA (N2) non-small cell lung cancer after 2 cycles of platinum-based chemotherapy and/or 40 Gy or more of radiotherapy. The goals included biopsy of 3 negative N2 node stations or to identify 1 positive N2 node or pleural carcinomatosis.

Results

Ten institutions accrued 68 subjects. Of the 68 subjects, 46 (68 % ) underwent radiotherapy and 66 (97 % ) underwent chemotherapy. Videothoracoscopy successfully met the prestudy feasibility in 27 patients (40 % ): 3 negative stations confirmed at thoracotomy in 7, persistent stage N2 disease in 16, and pleural carcinomatosis in 4. In 20 procedures (29 % ), no N2 disease was found, 3 stations were not biopsied because of?unanticipated nodal obliteration. Thus, 47 videothoracoscopy procedures (69 % , 95 % confidence interval, 57 % -80 % ) restaged the mediastinum. Videothoracoscopy was unsuccessful in 21 patients (31 % ) because the procedure had to be aborted (n?=?11) or because of false-negative stations (n?=?10). Of the 21 failures, 15 were right-sided, and 10 had a positive 4R node. The sensitivity of videothoracoscopy was 67 % (95 % confidence interval, 47 % -83 % ), and the negative predictive value was 73 % (95 % confidence interval, 56 % -86 % ) if patients with obliterated nodal tissue were included. The sensitivity was 83 % (95 % confidence interval, 63 % -95 % ) and the negative predictive value was 64 % (95 % confidence interval, 31 % -89 % ) if those patients were excluded. The specificity was 100 % . One death occurred after thoracotomy.

Conclusions

Videothoracoscopy restaging was ¡°feasible¡± in this prospective multi-institutional trial and provided pathologic specimens of the ipsilateral nodes. Videothoracoscopy restaging was limited by radiation and the 4R nodal station.