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Rebuttal From Drs Tanner and SilvestriRebuttal From Drs Tanner and Silvestri

Nichole T. Tanner, MD, MSCR, FCCP; Gerard A. Silvestri, MD, FCCP
Author and Funding Information

From the Ralph H. Johnson Veterans Affairs Hospital (Dr Tanner), Health Equity and Rural Outreach Innovation Center; and the Division of Pulmonary and Critical Care, Allergy and Sleep Medicine (Drs Tanner and Silvestri), Medical University of South Carolina.

CORRESPONDENCE TO: Nichole T. Tanner, MD, MSCR, FCCP, Division of Pulmonary and Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Ste 812-CSB, Charleston, SC 29425; e-mail: tripici@musc.edu


CONFLICT OF INTEREST: N. T. T. has received grant funding from the CHEST Foundation OneBreath Initiative, American Cancer Society, Olympus Corporation of the Americas, and Cook Medical Inc and consulting fees from Integrated Diagnostics Inc; Cook Medical Inc; Veran Medical Technologies, Inc; and Olympus Corporation of the Americas. None declared (G. A. S.).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(6):1379-1380. doi:10.1378/chest.15-1195
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Extract

Dr Li and colleagues1 make four arguments in favor of adding surgery to current guideline-directed standard-of-care chemoradiotherapy alone for treatment of patients who present with superior sulcus tumor (SST) and mediastinal (N2) lymphadenopathy. The first assertion is that research regarding treatment strategies in this population occurred before the trimodality era and, therefore, should be revisited. We agree. Patients with SSTs treated before trimodality therapy did not do well, and those with N2 disease did even worse. The trials that used trimodality therapy for SSTs had better outcomes, but the majority excluded patients with N2 disease. These findings led to the 2013 American College of Chest Physicians (CHEST) lung cancer guidelines recommending this approach for patients with SSTs and N0-1 disease2-5 as well as to the rationale for why the guidelines recommend against surgery in patients with SSTs and N2 disease.2 Armed with these data, our colleagues suggest that the “promising results” from the aforementioned trials should lead us to consider broadening the patient selection strategy to include N2 disease, and they point to several studies to augment this position, the second tenant of their argument.

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