79IN - Who should be considered for surgery for stage III disease and why?
|Date||30 September 2012|
|Event||ESMO Congress 2012|
|Session||Hot topics in early stage NSCLC|
|Topics|| Non-Small-Cell Lung Cancer, Locally Advanced
Surgery and/or Radiotherapy of Cancer
For the treatment of patients with locally advanced NSCLC is important to recognize the variety of manifestations of the disease and the heterogeneity in the subgroups, so that surgery, multidisciplinary care or non-surgical approach can be tailored to the individual patient. For stage T3N1 and T1-3 N2A1/2 disease primary complete resection and systematic lymphadenectomy is beneficial for patients with functional and medical operability. Adjuvant chemotherapy is recommended. After incomplete resection reoperation is indicated, otherwise radiation is necessary. Patients with functional and/or medical inoperability are best treated by simultaneous or sequential chemo-/ radiotherapy or radiotherapy alone. For stageT1-3 N2A3 disease by technically resectabel patients, induction treatment (CTx or CTx/RTx) followed by resection results the best long term results. For patients with surgery and R0 resection after induction CTx alone, postoperative RTx is recommended. For patients with single LNstation involved, primary surgery followed by CTx/RTx is possible. For patients with StageT1-3 N2A4 bulky disease and acceptable performance status, combination of chemotherapy and radiation is the choice of treatment. For selected cases after induction chemotherapy and good response the integration of surgery could be followed (if possible inside of studies). For stage T4N0-1 disease primary surgery or integration of surgery in a multimodality treatment is recommended for patients with functional and medical operability and involvement of carina, trachea, atrium, vena cava, pulmonary artery, vertebral body or metastasis in other lobe ipsilateral. Treatment strategies for IIIB disease are reduction of tumor associated symptoms and increasing of survival. For stageT4 N2, T1-3N3 disease combination of chemotherapy and radiation is the choice of treatment. For selected cases after induction CTx/RTx and good response the integration of surgery could be followed (if possible inside of studies). For sulcus superior tumors stage II-IIIB induction CTx/RTx followed by surgery is recommended. Technical or functional inoperable patients should receive a definitive CTx/RTx. The multidisciplinary approach maximizes the chance of long term survival and minimizes the treatment related morbidity and mortality.Disclosure
The author has declared no conflicts of interest.