Open Access Research article

Trimodal therapy for stage III-N2 non-small-cell lung carcinoma: a single center retrospective analysis

Vasileios Askoxylakis1*, Judith Tanner1, Jutta Kappes2, Hans Hoffmann3, Nils H Nicolay1, Harald Rief1, Juergen Debus1, Michael Thomas245 and Marc Bischof1

Author Affiliations

1 Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany

2 Department of Pulmonary and Respiratory Care Medicine, Thoraxklinik Heidelberg, University of Heidelberg, Heidelberg, Germany

3 Department of Thoracic Surgery, Thoraxklinik Heidelberg, University of Heidelberg, Heidelberg, Germany

4 Department of Internal Medicine – Thoracic Oncology, Clinic for Thoracic Diseases, University of Heidelberg, Heidelberg, Germany

5 Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany

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BMC Cancer 2014, 14:572  doi:10.1186/1471-2407-14-572

Published: 7 August 2014



Treatment of locally advanced non-small-cell lung cancer is based on a combined approach. To study the impact of trimodal therapy for stage III-N2 NSCLC a single centre retrospective evaluation focusing on survival and therapy-related toxicity was performed.


71 patients diagnosed between March 2001 and August 2008 with pathologically confirmed stage III-N2 non-small-cell lung cancer at the University Clinic of Heidelberg were retrospectively analyzed. All patients were treated within trimodal therapy strategies including surgery, induction or adjuvant chemotherapy and postoperative radiotherapy. Overall survival (OS) and disease free survival (DFS) rates were calculated using the Kaplan-Meier method. The log-rank test and Fishers Exact test were applied for univariate analysis and Cox proportional regression model for multivariate analysis.


Median survival was 32 months. 1-, 3- and 5-year overall survival (OS) rates were 84.5%, 49.6% and 35.5% respectively. Disease free survival rates at 1, 3 and 5 years were 70.4%, 41.8% and 27.4% respectively. 9 patients (12.6%) were diagnosed with a local recurrence. Multivariate analysis did not reveal any independent prognostic factors for OS, but indicated a trend for pT stage and type of surgery. In regard to toxicity 8.4% of the patients developed a clinically relevant ≥ grade 2 pneumonitis. Evaluation of the forced expiratory volume in 1 second per unit of vital capacity (FEV1/VC) before and 1-3 years post radiotherapy revealed a median decrease of 2.1%.


Our descriptive data indicate that trimodal therapy represents an effective and safe treatment approach for patients with stage III-N2 non-small-cell lung cancer. Further prospective clinical trials are necessary in order to clearly define the impact of multimodal strategies and optimize NSCLC treatment.

NSCLC; Stage III-N2; Trimodal treatment; Radiotherapy