Dr. Nasser Hanna, Indiana University Health, describes the factors which determine whether stage III NSCLC is resectable.
So what defines stage III, unresectable non-small cell lung cancer? Well first it’s important to distinguish patients who have potentially resectable stage III disease, versus those who have unresectable stage III disease. In general, stage III disease is defined by disease that involves the mediastinum. The mediastinum is this compartment in the midsection of your chest that lies between the two lungs — the heart, lymph nodes, the esophagus, the trachea, various blood vessels reside in that region. When disease involves the mediastinum, that section between the two lungs, oftentimes it is difficult for a surgeon to surgically resect it and to get all the disease out that they can see. So the vast majority of people who have disease involving the mediastinum will be considered to have unresectable disease.
There are some exceptions to this — there are some patients who we think may have stage I or stage II disease that does not involve the mediastinum. The surgeon will routinely do surgery and will remove lymph nodes in that portion of the chest, and will incidentally find that there is cancer in the lymph nodes. In that case those patients also have stage III disease, but they were able to undergo a surgical resection.
There are also a small subset of patients who have clinically known disease in the mediastinum that’s low volume that may require a lesser surgical resection. Occasionally patients will be able to undergo surgery in that group. However the vast majority of people are going to have pretty advanced disease in the midsection. They’re going to have multiple lymph nodes that are enlarged, they’re going to have tumors that involve major structures, they’re going to require large operative procedures. For those patients, we consider them to be unresectable.
I would estimate that probably 3/4, maybe 80% of people who are diagnosed with stage III disease would be considered unresectable, and some patients may be technically resectable, but they may be medically inoperable. In other words, removing the lung or doing that sort of operative intervention might be too difficult for them, they may not have the heart reserve or the lung reserve to be able to survive a procedure like that. So that group of patients oftentimes is also not treated with surgery.
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