What is your preferred approach for stage III NSCLC with single station N2 disease amenable to lobectomy?

The question of how to handle operable IIIA patients with limited N2 disease has always been controversial, and the new PACIFIC data just makes it more complicated.

At some level, it becomes a duel of unplanned subset analysis and a bit of apples to oranges, which is always to be taken with a grain o...

Our Intergroup trial of C/RT pre-op or C/RT to full (61Gy) was reported initially to have better PFS. The improved OS never emerged. Some claim the high mortality with pneumonectomy among group surgeons (inexperience, skill deficit), but others claim that the subset having lobectomy survived better...

Though not randomized, the data from Vyfhuis, et. al reported the outcomes of stage III patients treated to full dose CRT followed by surgery, or those treated with bimodality treatment (either planned or unplanned). The median survival for patients treated with trimodality therapy was ~60 months. T...

Durvulumab is only approved in the definitive setting after chemoradiation. It's a real home run as the follow up data continues to mature from the Pacific trial.

No clear OS benefit to surgery so imo all these patients should be getting chemo/rt+Durvulumab for optimal outcome

Another complication is that, at least, in my neighborhood, thoracic surgeons will NOT do thoracoscopic lobectomy and lymphadenectomy AFTER preoperative radiotherapy. Many surgeons are no longer interested in doing open surgery at all!Therefore, a very likely scenario we see is that patients will ge...