Article and Video CATEGORIES

Cancer Journey

Search By

Neoadjuvant Chemotherapy vs. Chemo/Radiation for Stage IIIA NSCLC
Mon, 02/08/2016 - 06:00
Author
GRACE Videos and Articles
GRACE Cancer Video Library - Lung

GCVL_LU-E04_Mark_Socinski_WCLC_4

 

Dr. Mark Socinski, University of Pittsburgh Medical Center, compares the use of chemotherapy to chemo/radiation in the preoperative setting in stage IIIA lung cancer.

 

Download Transcript

 

Transcript

As I previously mentioned, the role of surgery in stage IIIA disease remains controversial, although there are many patents who are suitable candidates for this, and for whom this approach is a very reasonable approach. One of the questions that is often raised in this situation is: what type of treatment should the patient receive prior to going into the operating room? As I previously mentioned, if you document N2 disease, and in this case IIIA disease, going to the operating room should not be the initial therapeutic approach in these patients, and we generally believe that they need preoperative therapy. The two choices are chemotherapy alone, versus chemoradiation.

We actually have no good data to guide us in this way — both approaches seem to be reasonable, both approaches are backed by previous trials addressing these sorts of things. One of the issues with regard to chemoradiation is that one has to be careful about the dose in the field of radiation, as well as the timing of surgery, following this to avoid postoperative complications that can be difficult to manage in the postoperative setting.

Obviously with chemotherapy alone, you don’t have the risks of radiotherapy. There is some evidence to suggest that, perhaps, chemoradiation may improve local/regional control relative to chemotherapy; it may increase the rate of what we call downstaging, which we think is a positive prognostic thing. What I mean by downstaging is, if you know the lymph nodes are positive at the time of initial diagnosis, if you employ chemotherapy or chemoradiation at the time of surgical resection, those lymph nodes that were positive pretreatment are now negative, so the chemotherapy and chemoradiation had an effect. We tend to see higher downstaging rates with chemoradiation, and downstaging has been associated with improved survival in this population, so that might argue for preoperative chemoradiation as a more reasonable strategy, but the data is not entirely clear in this regard.

One thing I will say is that, whether it’s preoperative chemotherapy, or preoperative chemo/radiotherapy, the surgeon involved should be involved right from the beginning. He or she should be an experienced surgeon that does this quite often, so they know how to manage patients both prior to the operation, intraoperatively, as well as postoperatively to minimize the risk of some of the complications such as ARDS, volume overload, postoperative infections and arrhythmias, and those sorts of things really should be managed in experienced hands from the thoracic surgeon point of view.

Video Language

Next Previous link

Previous PostNext Post

Related Content

Forum Discussions

Hi Stan! It's good to see you. I can only imagine what this last year has been like for you and hope the grieving is getting more manageable every day. GRACE...

It is so good to hear from you, and my sentiments are the same as Janine's.  You are definitely why we do this, and we truly appreciate your kind words.  Happiest...

Stan, thanks so much for sending this very kind note. It is because of people like you and Sara that we are so tirelessly dedicated to our mission of helping to...

Hi and welcome to GRACE.  I'm sorry mother is experiencing oligoprogrssion.  This often happens when some of the cancer cells acquire a resistance to alecensa's effects.  Those cells can be radiated...

help Mom to continue using Alectinib. Thank you for the video list as well. Is there any experience or some period in which SBRT works, is it individual or are there...

Oh yes! SBRT (Stereotactic body radiation therapy) is a very focused type of radiation that is able to target and kill the tumor without the destruction of healthy tissue. The goal...

Hi again, thank you very much for the detailed response. I hope that SBRT will help my mom and that she will use Alecensa for a long time and after Alecensa...

Recent Comments

JOIN THE CONVERSATION
Same EGFR G719A and S768I mutations in mom
By Beh368 on Wed, 12/07/2022 - 12:00
Good to hear from you, Stan!
By Amy B on Wed, 12/07/2022 - 09:19
Have you registered?
By JanineT Forum … on Mon, 12/05/2022 - 20:24
Thank you Stan!
By Amy B on Fri, 12/02/2022 - 14:02