Stage 3A lung cancer, where the cancer has spread to lymph nodes on the same side of the chest as the cancer, can be something of a “gray zone” when it comes to treatment decisions, according to Dr. Joseph Friedberg, chief of the Division of Thoracic Surgery at the University of Maryland. So doctors may disagree on how to approach this stage of the disease.
Dr. Friedberg says that in his opinion, it may be appropriate to give chemotherapy with or without radiation before surgery to people who are young and/or are otherwise healthy individuals. The goal is to shrink the tumor and kill all errant cancer cells before surgery and then to remove the now smaller tumor.
In the latest version of the National Comprehensive Cancer Network Lung Cancer Guidelines, one third of the NCCN member institutions use combination chemotherapy/radiation prior to surgery for IIIA disease, while two-thirds use only chemotherapy.
Dr. Friedberg says a controversial approach for treating 3A lung cancer is the removal of an entire lung, which obviously has a significant impact on a patient’s quality of life. The NCCN Lung Cancer Panel agrees: “The role of surgery in patients with pathologically documented (IIIA) disease remains controversial.”
The NCCN panel notes that two clinical trials evaluated the role of surgery in this population and did not show an overall survival benefit with the use of surgery. But the panel notes that it believes that these trials “did not sufficiently evaluate the nuances with the heterogeneity of N2 disease” and the likely benefit of surgery in some situations.
Surgery is often followed by chemotherapy, immunotherapy or radiation.
If surgery, radiation and chemotherapy are not options, certain immunotherapy treatments such as Keytruda (pembrolizumab) may be used alone as your first treatment.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Joseph Friedberg serves as a medical advisor to SurvivorNet. He is the Charles Reid Edwards Professor of Surgery and head of the Division of Thoracic Surgery at the University of Maryland School of Medicine. Read More
Stage 3A lung cancer, where the cancer has spread to lymph nodes on the same side of the chest as the cancer, can be something of a “gray zone” when it comes to treatment decisions, according to Dr. Joseph Friedberg, chief of the Division of Thoracic Surgery at the University of Maryland. So doctors may disagree on how to approach this stage of the disease.
Dr. Friedberg says that in his opinion, it may be appropriate to give chemotherapy with or without radiation before surgery to people who are young and/or are otherwise healthy individuals. The goal is to shrink the tumor and kill all errant cancer cells before surgery and then to remove the now smaller tumor.
Read More In the latest version of the
National Comprehensive Cancer Network Lung Cancer Guidelines, one third of the NCCN member institutions use combination chemotherapy/radiation prior to surgery for IIIA disease, while two-thirds use only chemotherapy.
Dr. Friedberg says a controversial approach for treating 3A lung cancer is the removal of an entire lung, which obviously has a significant impact on a patient’s quality of life. The NCCN Lung Cancer Panel agrees: “The role of surgery in patients with pathologically documented (IIIA) disease remains controversial.”
The NCCN panel notes that two clinical trials evaluated the role of surgery in this population and did not show an overall survival benefit with the use of surgery. But the panel notes that it believes that these trials “did not sufficiently evaluate the nuances with the heterogeneity of N2 disease” and the likely benefit of surgery in some situations.
Surgery is often followed by chemotherapy, immunotherapy or radiation.
If surgery, radiation and chemotherapy are not options, certain immunotherapy treatments such as Keytruda (pembrolizumab) may be used alone as your first treatment.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Joseph Friedberg serves as a medical advisor to SurvivorNet. He is the Charles Reid Edwards Professor of Surgery and head of the Division of Thoracic Surgery at the University of Maryland School of Medicine. Read More
