Patients with adenopathy on CT should also undergo more invasive staging by one of the methods described previously. Ten per cent of patients with NSCLC and positive N2 disease have single, ipsilateral, intracapsular spread only and are still candidates for resection . The remainder may be candidates for neoadjuvant therapy. Such regimens for stages IIIA and IIIB have been described, with a subsequent complete resection rate as high as 73% .
Although there have been occasional reports of survivors with NSCLC with stage IV disease following surgery, the role of resection has generally been limited to patients with isolated, resectable, cranial metastases . Usually craniotomy precedes thoracotomy to ensure complete resectability, the absence of other occult metastases and full patient recovery. Resection in patients with isolated adrenal metas-tases has also been described with a 38% three-year survival rate, but this approach is still investigational. Efficient treatment has got less costly: find Purchase Zyrtec at best online pharmacy.