There were 117 responses to this survey, with the majority
of surgeons living in North America and Europe.
Just over half of physicians use PET routinely for evaluating
N2 disease.
One third of physicians use PET only when mediastinal or hilar
lymph nodes are abnormal on CT.
The vast majority of surgeons believe that histologic confirmation
is necessary when CT and PET show abnormal N2 lymph nodes.
Most surgeons perform mediastinoscopy only when there is evidence
on CT or PET for abnormal hilar or mediastinal nodes.
The vast majority of surgeons do not operate on documented
N2 disease until completion of induction therapy.
The was a considerable range of opinions on how to manage N2
disease after induction therapy, with responses equally divided among requiring
sterilization of N2 nodes, clinical response in N2 nodes, or completely resectable
disease.
1.
Under what circumstances do
you perform a PET scan?
Response Percent
Response Total
a. Only when
there is CT evidence for mediastinal
adenopathy
20.5%
24
b. Only when
there is CT evidence for mediastinal
OR hilar adenopathy
12.8%
15
c. Routinely
54.7%
64
d. Never
12%
14
Total Respondents
117
(skipped
this question)
0
2.
In a patient with CT and PET
evidence for N2 disease, do
you feel histologic or cytologic
documentation is necessary
to confirm these findings prior
to recommending therapy?
Response Percent
Response Total
a. Yes
92.3%
108
b. No
7.7%
9
Total Respondents
117
(skipped
this question)
0
3.
Under what circumstances do
you perform mediastinoscopy?
Response Percent
Response Total
a. Only
when there is CT and/or PET evidence
for mediastinal adenopathy
59%
69
b. Only when
there is CT and/or PET evidence for
mediastinal OR hilar adenopathy
27.4%
32
c. Routinely
12%
14
d. Never
1.7%
2
Total Respondents
117
(skipped
this question)
0
4.
Under what circumstances do
you operate on documented N2
disease prior to administration
of systemic therapy or radiotherapy?
Response Percent
Response Total
a. Only when
single station disease is evident
and resectable
18.8%
22
b. Whenever
the disease is completely resectable
6%
7
c. I don't
operate prior to induction therapy
71.8%
84
d. I don't
operate on N2 disease
3.4%
4
Total Respondents
117
(skipped
this question)
0
5.
In a patient with initial histologically
documented N2 disease who has
completed induction chemotherapy
and radiation therapy, under
what circumstances do you resect?
Response Percent
Response Total
a. I don't
operate on N2 disease
0.9%
1
b. Only if
a substantial treatment response
is evident
31.6%
37
c. Only if
the N2 nodes have been sterilized
23.1%
27
d. Whenever
the disease appears completely resectable
