Surgical Dilemmas in the Management of Locally Advanced NSCLC - 102262

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Surgical Dilemmas in the Management of Locally Advanced NSCLC

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Description: Jessica S. Donington, MD of NYU Langone Health discusses the surgical dilemmas in the management of locally advanced NSCLC. Dr. Donington cites question related to 3A diseases like “Should surgery be used at all?” “What kind of induction or timing?” and more questions on immunotherapy for 3A. For resectable 3A disease, there is a strong evidence that patients who undergo lobectomy for their cancer, the use of induction therapy plus surgery still provide patients the better chance for cure. This change fairly dramatically for patients who might need extended resections by lobectomy, pneumonectomy and the like. The surgical short-term outcome might not be that good, nor is the long-term. So, for surgeons, the line between lobectomy or more is very important, and decisions should be made before starting any treatment and not after induction.

Another interesting question in surgery and 3A is on whether just induction chemotherapy alone or induction chemotherapy plus radiation therapy. There was a big trial in Europe that claimed to have answered this question, but, doctors in the US would argue that their chemotheraphy and radiation wasn’t really ideal as what is seen in the US. No one has the right answer for this question as of the moment. However, what is know is that adding chemotherapy and radiation will improve mediastinal nodal clearance, pathologic complete response and although these were the best markers for overall survival, unfortunately, this might not turn out well in the future. So, it’s still very important to dig a little deeper into this.
Shared By : thoraciconcology
Posted on : 12/28/17
Added : 9 months ago