Article and Video CATEGORIES

Cancer Journey

Search By

Lung Cancer Video Library - Defining Resectability in Stage IIIA Lung Cancer
Tue, 02/09/2016 - 06:00
Author
GRACE Videos and Articles
Dr. Mark Socinski, University of Pittsburgh Medical Center, discusses the factors to consider in defining resectability in stage IIIa lung cancer.

 

 

Transcript

Defining resectability in stage III lung cancer really needs to be under the supervision of a qualified thoracic surgeon. Ultimately, I say that no one but a surgeon should make the distinction of whether a patient is resectable or unresectable. Medical oncologists shouldn’t do it, pulmonologists shouldn’t do it, and radiation oncologists shouldn’t do it. These are specialties that are often involved, but really, the surgeon is the ultimate decision maker.  Now, obviously we can collaborate and discuss issues with regard to resectability with the surgeon, but I think ultimately, it comes down to that decision making process.

Now, obviously, resectability has to focus around two things — can you remove the primary tumor, and as we previously mentioned, T3 lesions that involve the pericardium, the diaphragm, the chest wall — these can typically be resected en bloc, taking part of the chest wall or part of the pericardium. I think that for experienced thoracic surgeons, that is not a difficult procedure. I think there are many questions when you start to have T4 lesions that involve vital structures such as the esophagus, the trachea, the great vessels, perhaps the spinal column, bony disease in that area — there are highly selected situations in which one may consider that with obviously, reconstruction of the vital structures. But, these are very few and far between, they need to be done by very experienced surgeons and a team of medical oncology and radiation oncology before I would embark on that sort of decision. T3 is a little bit easier than T4.

The second issue, and more common issue, is with regard to the mediastinal lymph nodes. Now obviously, if you have bilateral mediastinal involvement, and this would be both N2 and N3 — N2 being in the same side as the cancer, N3 being on the opposite side of the cancer, then we would say that patient is not resectable. N3, by definition, should preclude surgery and really is treated optimally with chemoradiation. The real issue centers down to those patients who have isolated N2 disease.

Now, there’s not universal agreement about what’s resectable and what’s not resectable. Certainly, if you have small lymph nodes measuring less than 2cm, and particularly if it’s only in one site, I think most people would consider those patients potentially resectable. The question starts to evolve when one gets into a situation of what we refer to as bulky lymph node involvement. Bulky is a bit of a random definition, most of us use over 2-3cm, and if you have that bulk, as particularly in multiple nodal stations, besides the trachea or the subcarinal area. I think with most of those patients, the likelihood that surgery is going to be able to completely sterilize the mediastinum is quite low, and I would consider that those patients would not be resectable, in that they should be best served by the combination of chemoradiotherapy, which still offers patients a chance at being cured, and as I have previously mentioned, it’s not clear in this population that surgery improves the overall cure rate of this subset of patients.

So I think, really in the non-bulky, particularly isolated, one-site lymph node involvement — that would be a patient that we may consider for preoperative treatment, either chemotherapy or chemoradiation as we talked about before; those would be considered potentially resectable patients.

Video Language

Next Previous link

Previous PostNext Post

Related Content

Image
Mandarin LCVL
Video
王林医生用普通话讨论重要的肺癌信息。这些信息包括靶向治疗、晚期疾病的症状、循环肿瘤 DNA、治疗方案等。我们鼓励您与社区中说普通话的人分享。 Dr. Lin Wang discusses important lung cancer information in Mandarin. This information includes targeted therapy, symptoms of advanced disease, circulating tumor DNA, treatment options, and more. We encourage you to share this with the Mandarin speakers in your community. To watch the complete Playlist visit: https://www.youtube.com/playlist?list=PLWsyUmdjLXhGnSxobmz4CBP3pxAj7nDa…;  
Image
Tell your story!  Apply now for the Clinical Trials Experiences through Storytelling Program
Article
We are excited to launch our third year of this program; tell your story and help us help others! Apply Online Now!     GRACE Patient Perspectives: Clinical Trials Experiences Storytelling Program Overview  
Image
Blood Cancer OncTalk
Video
Blood Cancer OncTalk was a live presentation that brought together top oncologists to discuss emerging concepts and treatment options in blood cancer. The program was chaired by Dr. Aaron Goodman, with the participation of Dr. Mazie Tsang, Hematologist / Oncologist; Dr. Autumn Jeong, Hematologist / Oncologist; Dr. Shaji Kumar, Hematologist / Oncologist; and Dr. Sridevi Rajeeve, Hematologist / Oncologist.

Forum Discussions

Hi Caregiver and welcome to Grace.  I'm sorry that you need to be here and hope we can help.  Osimertinib has better efficacy than gefitinib (including OS and reaching the brain)...

Hi Bob, Welcome to Grace.  I'm sorry about your sil.  Unfortunately, cancer becomes resistant to TKIs like tagrisso.  Sometimes all of the cancer becomes resistant at once and sometimes just parts...

Recent Comments

JOIN THE CONVERSATION
Hi Tammy,  Welome to Grace. …
By JanineT GRACE … on Tue, 05/16/2023 - 13:44
Concerned
By Tndiuka10 on Fri, 05/12/2023 - 21:13
Hi Caregiver and welcome to…
By JanineT GRACE … on Fri, 05/12/2023 - 14:20
Hi Bob, Welcome to Grace.  I…
By JanineT GRACE … on Tue, 05/02/2023 - 12:29