87P - What to do for the treatment of non small cell lung cancer (NSCLC) with a single mediastinal lymph node involvement (N2a disease) in developing coun...

Date 17 April 2015
Event ELCC 2015
Session Poster lunch
Topics Bioethics, Legal, and Economic Issues
Non-Small-Cell Lung Cancer, Locally Advanced
Presenter Fatmir Caushi
Citation Annals of Oncology (2015) 26 (suppl_1): 24-28. 10.1093/annonc/mdv049
Authors F. Caushi1, H. Hafizi2, D. Xhemalaj3, A. Mezini2, I. Skenduli1
  • 1Thoracic Surgery, University Hospital of Lung Disease "Shefqet Ndroqi", 12345 - Tirana/AL
  • 2Pneumology, University Hospital of Lung Disease "Shefqet Ndroqi", Tirana/AL
  • 3Pathologic Anatomy, University Hospital of Lung Disease "Shefqet Ndroqi", Tirana/AL



The debate over the treatment of NSCLC with N2 disease is too old and it still continues. Questions like “What to do with an N2 positive even after neoadjuvant chemotherapy?” or “Does the adjuvant chemotherapy immediately after surgery have the same result of neoadjuvant chemotherapy plus surgery?” are still without a definitive response. Sometimes it is up to the decision of the surgeon to continue surgery in an N2a found during surgery. The success of neoadjuvant chemotherapy was claimed and approved by everybody interested in this field but there is a big question about the appliance of the protocols where the possibilities are limited. Is the surgical treatment of N2a accompanied by adjuvant chemo-radiotherapy a better possibility for our patients?


We performed a retrospective study with the aim of evaluating the 5-year survival of patients that were diagnosed as N2a prior to surgery and had not undergone neoadjuvant chemotherapy. The surgery was followed immediately by adjuvant chemo-radiotherapy. In this study we observed 40 patients that consitute 7% of all patients operated on for NSCLC.


We found that in patients operated on for NSLC with N2a disease the 5-year survival was 23%, while no case of death was reported during the first year after the surgery. 83% of the patients underwent lobectomy and segmentectomy, the rest received pneumonectomy. In 95% of them the surgery was followed only by adjuvant chemotherapy while in 5% of cases the surgery was followed by chemo-radiotherapy.


Comparing the 5-year survival rate with the studies of other authors on N2a disease and facing the problem of a deficiency of feedback for patients recommended for neoadjuvant treatment, it was concluded that is better to perform surgery on N2a disease followed by adjuvant chemo-radiotherapy. Although guidelines are products of diverse scientific trials, it is useful to apply them based on the possibilities that the medical staff has available.


All authors have declared no conflicts of interest.