Outcomes of invasive mediastinal nodal staging versus positron emission tomography staging alone for early-stage non-small cell lung cancer treated with stereotactic body radiation therapy

•Invasive mediastinal nodal staging (IMNS) pathologically samples mediastinal nodes.•The benefit to IMNS over positron emission tomography (PET) alone is undefined.•This multi-institutional study of 180 patients sought to address this issue.•Patients receiving IMNS had similar survival and patterns...

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Published in:Lung cancer (Amsterdam, Netherlands) Netherlands), 2018-03, Vol.117, p.53-59
Main Authors: Schonewolf, Caitlin A., Verma, Vivek, Post, Carl M., Berman, Abigail T., Frick, Melissa A., Vachani, Anil, Lin, Chi, Simone, Charles B.
Format: Article
Language:English
Subjects:
Endobronchial ultrasound
Mediastinoscopy
Non-small cell lung cancer
Positron emission tomography
Stereotactic ablative radiotherapy
Stereotactic body radiation therapy
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Summary:•Invasive mediastinal nodal staging (IMNS) pathologically samples mediastinal nodes.•The benefit to IMNS over positron emission tomography (PET) alone is undefined.•This multi-institutional study of 180 patients sought to address this issue.•Patients receiving IMNS had similar survival and patterns of failure as PET alone.•Further study is needed to determine which subgroups might benefit from IMNS. The benefit of invasive mediastinal nodal staging (IMNS) in addition to positron emission tomography-computed tomography (PET/CT) is undefined for early stage non-small cell lung cancer (NSCLC). This multi-institutional investigation aimed to evaluate outcomes and patterns of failure in patients staged with PET/CT with or without additional IMNS. Two academic centers assessed all consecutive patients staged with PET/CT for early-stage, primary lung NSCLC (cT1-2aN0M0) treated with SBRT. Local recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated using Kaplan-Meier methodology. Univariate and multivariate Cox proportional hazards modeling addressed factors associated with outcomes. Overall, 180 patients (199 lesions) were staged with PET/CT alone and 56 patients (58 lesions) underwent additional IMNS. Among patients receiving IMNS, 52 (93%) underwent EBUS and 4 (7%) underwent mediastinoscopy. At a median follow-up of 33.5 months (range, 1.9–80.9 months), there was no significant difference in LRFS (37 vs. 47 months, p=0.309), NRFS (34 vs. 42 months p=0.370), DMFS (36 vs. 47 months, p=0.234) or OS (37 vs. 47 months, p=0.236) between patients undergoing PET/CT-only versus PET/CT+IMNS staging, respectively. Receipt of IMNS did not correlate with any outcome on either univariate or multivariate analysis (p>0.05). Patterns of failure in both groups were similar, including crude isolated nodal failure rates (8% PET/CT-only versus 14% PET+IMNS group, p=0.202). Patients undergoing IMNS had similar survival and patterns of recurrence as those receiving PET/CT alone. Further study, ideally prospectively, is needed to determine which subgroups might benefit from IMNS.
ISSN:0169-5002
1872-8332
DOI:10.1016/j.lungcan.2017.07.005