GRACE :: Lung Cancer


nodal involvement

Dr West

Modifying Factors: Should Patients with Smaller Resected Node-Negative NSCLC Tumors Receive Adjuvant Chemo?


While post-operative chemotherapy for early stage NSCLC is a well-established standard for relatively healthy patients with stage II or higher resected cancers, the question of whether adjuvant chemotherapy is more likely to help or hurt a patient remains more a matter of debate.  Much of the debate has focused on a threshold of tumor size, with 4 cm emerging as a cutoff, above which chemotherapy appears more likely to be helpful and is often recommended.  The general concept is that adjuvant chemotherapy confers a benefit that is proportional to the risk of the cancer recurring — a higher risk cancer is more likely to have the risk reduced by chemo more than enough to counterbalance the acute and chronic side effects of adjuvant chemo.  But while tumor size is certainly one of the more readily identifiable factors associated with risk of recurrence and death, it’s not the only relevant factor. The National Comprehensive Cancer Network (NCCN) also includes several other factors in its guidelines for consideration of adjuvant chemotherapy, even for smaller tumors, so let’s review those.  

I covered the issues of tumor histology and pleural invasion in a prior post.  In addition, vascular invasion, or tumor cells invading into blood vessels, is associated with increased risk. In fact, as shown in the figure to the left, T1 (smaller) cancers with vascular invasion have a worse outcome than T2 (larger) cancers that don’t have vascular invasion.



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