- Neoadjuvant chemotherapy (NACT)+surgery and adjuvant radiotherapy (CSR sequence) and NACT+surgery and adjuvant chemotherapy (CSC sequence) offer the best OS for stage IIIA-N2 NSCLC, according to a meta-analysis.
Why this matters
- Studies on the optimal treatment for N2 disease have yielded conflicting results.
- Meta-analysis of 18 randomized controlled trials with 2158 patients with stage IIIA-N2 NSCLC.
- Funding: None disclosed.
- Best treatments:
- CSC and CSR had the lowest mortality risk (both 29%).
- CSC and CSR offered the best OS (HR, 1.14, 95% credible interval [CrI], 0.21-5.93).
- CSR had significant survival benefit over:
- Surgery alone: HR, 0.38; 95% CrI, 0.18-0.81.
- Surgery followed by adjuvant radiotherapy: HR, 0.51; 95% CrI, 0.29-0.92.
- Significantly longer OS than surgery alone was also noted for:
- Surgery followed by adjuvant chemotherapy: HR, 0.77; 95% CrI, 0.60-0.99.
- NACT followed by surgery: HR, 0.61; 95% CrI, 0.37-0.99.
- Sequential chemoradiotherapy: HR, 0.57; 95% CrI, 0.33-0.99.
- Surgery followed by adjuvant concurrent chemoradiotherapy: HR, 0.67; 95% CrI, 0.46-0.99.
- Most treatments compared indirectly.
- No studies on targeted molecular therapy, immunotherapy, and other systemic treatments.