HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pierluigi Granone Paul Van Schil Alfredo Cesario Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Granone, P. Articles by Cesario, A. Search for Related Content PubMed PubMed Citation Articles by Granone, P. Articles by Cesario, A. Related Collections Related Article

J Thorac Cardiovasc Surg 2007;133:275-276
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Restaging patients with N2 (stage IIIa) non–small cell lung cancer after neoadjuvant chemoradiotherapy: A closer look at redo mediastinoscopy

^a Department of Thoracic Surgery, Catholic University, Rome, Italy
^b Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
^c Department of Internal Medicine and Cardio-Pulmonary Rehabilitation, IRCCS San Raffaele, Rome, Italy

To the Editor:

On the basis of the data obtained by the analysis of 93 locally advanced cases of non–small cell lung cancer clinically restaged after induction therapy, Cerfolio and coworkers¹ conclude that when repeat positron emission tomography (PET)/computed tomography (CT) is adopted either in the staging or restaging process, the percentage decrease in maximum standardized uptake value (maxSUV) of the primary tumor and involved lymph nodes is predictive of pathology, but pathologic assessment is still required because persistently high maxSUV "does not equate to residual cancer." We commend the authors for their valuable study. Along the line of discussion, Cerfolio and coworkers state that "repeat mediastinoscopy often is inaccurate and potentially dangerous, especially after chest irradiation" and that endoscopic ultrasonography–guided fine-needle aspiration (EUS-FNA) biopsy, despite being more precise and accurate, is "available only in few centers." We would like to amicably address the authors on this point on the basis of our own personal experience and confidence with redo mediastinoscopy. Pathologic reassessment of the mediastinum is strongly advisable in the setting of induction therapy for locally advanced non–small cell lung cancer because persistent N2 disease heralds a poor prognosis.

Shortly after the introduction of mediastinoscopy, redo procedures were considered to be technically impossible because of the scar tissue developing after the first intervention. However, in subsequent years, they were shown to be technically feasible also after induction chemotherapy. The most recent updated series of redo mediastinoscopy after induction chemotherapy are summarized in Table 1 ^2-5 and compared with the overall results of restaging by means of PET/CT in the study of Cerfolio and coworkers.¹ The latter data were extracted from Figure 2 and not reported as such by the authors. Published mortality and morbidity rates of redo mediastinoscopy are very low. Its main advantage consists of providing histologic evidence of mediastinal downstaging in contrast to the pure anatomic and histologic data given by means of PET/CT. Moreover, Cerfolio and coworkers advocate the use of maxSUV of the primary tumor and involved lymph nodes. In contrast to what its name suggests, maxSUV is not standardized among different PET scanners and centers, making comparison and adoption of the proposed values by other institutions impossible. Also, the high cost of PET/CT is not addressed by the authors.

View this table: [in this window] [in a new window]   TABLE 1. Results of redo mediastinoscopy after induction chemotherapy compared with results of PET/CT1-5

References

1. Cerfolio RJ, Bryant AS, Buddhiwardhan O. Restaging patients with N2 (stage IIIa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: a prospective study. J Thorac Cardiovasc Surg 2006;131:1229-1235.[Abstract/Free Full Text]
   
2. Pitz CC, Maas KW, van Swieten HA, de la Riviere AB, Hofman P, Schramel FM. Surgery as part of combined modality treatment in stage IIIB non-small cell lung cancer. Ann Thorac Surg 2002;74:164-169.[Abstract/Free Full Text]
   
3. Rami-Porta R, Mateu-Navarro M, Serra-Mitjans M, Hernandez-Rodriguez H. Remediastinoscopy: comments and updated results. Lung Cancer 2003;42:363-364.[Medline]
   
4. Stamatis G, Fechner S, Hillejan L, Hintherthaner M, Krbek T. Repeat mediastinoscopy as a restaging procedure. Pneumologie 2005;59:862-866.[Medline]
   
5. De Waele M, Hendriks J, Lauwers P, Ortmanns P, Vanroelen W, Morel AM, et al. Nodal status at repeat mediastinoscopy determines survival in non-small cell lung cancer with mediastinal nodal involvement, treated by induction therapy. Eur J Cardiothorac Surg 2006;29:240-243.[Abstract/Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pierluigi Granone Paul Van Schil Alfredo Cesario Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Granone, P. Articles by Cesario, A. Search for Related Content PubMed PubMed Citation Articles by Granone, P. Articles by Cesario, A. Related Collections Related Article