N2 the unknown.

The LungART trial showed that adjuvant radiation does not improve disease-free survival in patients with resected, N2 NSCLC. More recently, CheckMate-816 showed that neoadjuvant nivolumab and chemotherapy improve event-free survival with a pathologic complete response rate of 24%. With increasing use of neoadjuvant therapy, what should be done for patients with residual N2 disease after NAC? In this analysis of the NCDB, 1855 patients with clinical N2 disease were treated with NAC (no immunotherapy) and surgery from 2004 to 2017. Just over half (54%) were downstaged to pN0-1 while the rest (46%) had persistent N2 disease, and the former had superior overall survival (82.7 months v 50.7 months). Adjuvant RT had a detrimental effect among downstaged patients, but it was associated with improved survival among those with persistent N2 disease. | Komiya, Radiother Oncol 2022


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