Source: Annual Congress 2002 - Isolated lung perfusion and lung cancer
Disease area: Thoracic oncology

Abstract

Objectives. Despite technical difficulties due to mediastinal fibrosis, remediastinoscopy (reMS) can be a valuable tool in the restaging of non-small cell lung cancer (NSCLC) after neoadjuvant therapy. It may provide essential pathological information on mediastinal downstaging when selecting patients (pts.) for subsequent surgical resection. The aim of our study was to evaluate the feasibility, sensitivity and accuracy of reMS.
Material and methods. From November 1994 to May 2001 we performed a reMS in 27 pts. (24 men, 3 women) after neoadjuvant therapy for NSCLC. Their age ranged from 35 to 80 years (mean 61.9 ±] 11.9). Neoadjuvant therapy consisted of cisplatin-based chemotherapy in 24 pts. and chemoradiotherapy in 3 pts.
Results. In all 27 patients it was possible to perform a reMS without major technical difficulties and take biopsies of the lymph nodes that were initially invaded by tumor. ReMS was positive in 11 pts. (40.7 %) and negative in 16 pts. (59.3 %). In the 11 pts. with a positive reMS an unnecessary thoracotomy was avoided.
In 4 pts. reMS turned out to be false negative. So, in our series, sensitivity was 73 %, specificity 100 %, and accuracy 85 %. The positive and negative predictive values were 100 % and 75 %, respectively.
Conclusions. Previous mediastinoscopy is no contra-indication for a repeat one after neoadjuvant therapy. By offering valuable pathological information, reMS is an important restaging tool as persisting mediastinal involvement carries a poor prognosis in stage IIIA and IIIB NSCLC. Although sensitivity and accuracy are lower than that of a first mediastinoscopy, reMS is useful to select patients for surgical resection after induction therapy.

Rating:

Share or cite this content

Citations should be made in the following way:
P. E. Van Schil, J. H. F. van der Schoot, M. Pauwels, P. Germonpré, W. De Backer (Edegem, Belgium). Remediastinoscopy after neoadjuvant therapy for bronchogenic carcinoma. Eur Respir J 2002; 20: Suppl. 38, 1153

Member's Comments

No comment yet.

Related content which might interest you: Induction chemotherapy, concurrent chemoradiation and surgery for Pancoast tumour Source: Eur Respir J 2007; 29: 117-126 Year: 2007 Laser recanalisation prior to radiotherapy is required in some patients with inoperable nonsmall cell pulmonary carcinoma Source: Eur Respir J 2003; 22: Suppl. 45, 429s Year: 2003 Chemotherapy plus resection is not better than chemoradiotherapy for baseline unresectable stage IIIA-N2 NSCLC Source: ISSN=ISSN 1810-6838, ISBN=, page=380 Year: 2007 Quality-of-life determinants in bronchogenic carcinoma patients candidates for curative surgery Source: Eur Respir J 2006; 28: Suppl. 50, 137s Year: 2006 Surgery and multimodality treatment for malignant pleural mesothelioma Source: Eur Respir Mon; 2009: 44: 407–418 Year: 2009 Locally advanced inoperable non-small cell lung cancer (NSCLC) treated by weekly paclitaxel/carboplatin chemotherapy with concomitant radiotherapy Source: Eur Respir J 2007; 30: Suppl. 51, 433s Year: 2007 Treatment of potentially resectable locoregional (stage III) non-small cell lung cancer Source: Annual Congress 2005 - PG2 - Lung cancer: non-small cell lung cancer treatment Year: 2005 Survival and postoperative complication after neoadjuvant therapy in resectable stage IIIA-N2 non-small cell lung cancer: a balancing exercise Source: Eur Respir J 2003; 22: Suppl. 45, 31s Year: 2003 Induction chemotherapy and simultaneous radiochemotherapy or radiotherapy in inoperable NSCLC (stage IIIA/IIIB) Source: Eur Respir J 2002; 20: Suppl. 38, 399s Year: 2002 Long-term follow-up comparing postoperative chemotherapy or radiotherapy and surgery with surgery alone in resectable nonsmall cell lung cancer (NSCLC) Source: Eur Respir J 2001; 18: Suppl. 33, 131s Year: 2001 Pre-operative chemotherapy plus surgery versus surgery plus adjuvant chemotherapy versus surgery alone in early-stage nonsmall cell lung cancer Source: Breathe 2010; 7: 196-197 Year: 2010 Combination of neoadjuvant and adjuvant chemotherapy in marginally resectable IIIA nonsmall cell lung cancer (NSCLC): long-term follow up Source: Eur Respir J 2006; 28: Suppl. 50, 772s Year: 2006 Carcinomatous lymphangitis of a tracheal bifurcation in lung cancer: the role of neoadjuvant chemotherapy followed by surgery Source: Annual Congress 2008 - Congenital lung lesions and emphysema; lung cancer surgery Year: 2008 Impact of neoadjuvant therapy on tumor resectability and survival of patients with locally advanced non-small cell lung cancer Source: Annual Congress 2011 - General thoracic surgery II Year: 2011 Lymphoepithelioma-like carcinoma of the lung in a patient withsilicosis Source: Eur Respir J 2003; 22: 383-386 Year: 2003 Adjuvant and neoadjuvant therapy in nonsmall cell lung cancer (NSCLC) Source: Annual Congress 2006 - Clinical year in review Year: 2006 Cryotherapy as an adjuvant to radiotherapy in lung cancer Source: Eur Respir J 2005; 26: Suppl. 49, 76s Year: 2005 Impact of neoadjuvant therapies on surgical indications and early postoperative outcome Source: Annual Congress 2005 - Multidisciplinary treatment of non-metastatic non-small cell lung cancer: contemporary concepts Year: 2005 Postoperative lung cancer relapse after chemoradiation therapy Source: International Congress 2014 – Thoracic oncology grand round - an interactive session Year: 2014