This survey was posted during October 2006.

• 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 44.4% 52 Total Respondents   117 (skipped this question)   0

6. In what region do you work?   Response Percent Response Total     a. North America 53% 62     b. Europe 37.6% 44     c. South America 3.4% 4     d. Asia 6% 7     e. Africa 0% 0 Total Respondents   117 (skipped this question)   0