The Management of Patients With Stage IIIA Non–Small Cell Lung Cancer With N2 Mediastinal Node Involvement

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Patients with stage IIIA non–small cell lung cancer, determined based on involvement of ipsilateral mediastinal lymph nodes, represent the most challenging management problem in this disease. Patients with this stage disease may have very different degrees of lymph node involvement. The pathologic confirmation of this involvement is a key step in the therapeutic decision. The difference in the degree of lymph node compromise has prognostic and treatment implications. Based on multiple considerations, patients can be treated with induction chemotherapy, chemoradiotherapy followed by surgery, or definitive chemoradiotherapy without surgery. Data derived from clinical trials have provided incomplete guidance for physicians and their patients. The best therapeutic plan is achieved through the multidisciplinary cooperation of a team specialized in lung cancer.

Correspondence: Renato G. Martins, MD, MPH, Thoracic/Head and Neck Medical Oncology, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance/University of Washington, 825 Eastlake Avenue East, Seattle, WA 98109. E-mail: rgmart@u.washington.eduDr. Borghaei has disclosed that he is a consultant, on the advisory board, or on the speakers’ bureau for Eli Lilly and Company and Genentech, Inc. Dr. Kris has disclosed that he is a consultant for Roche and Genentech, Inc. The remaining authors have disclosed that they have no financial interests, arrangements, or affiliations with the manufacturers of any products discussed in this article or their competitors.
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