1 / 18

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?

belle
Download Presentation

Fontaine et al (2011)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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)

More Related