Treatment decisions for stage 3 non-small cell lung cancer (NSCLC) are primarily based on the patient's cancer status, overall health, and lung function, with the possibility of surgery varying accordingly. The treatment approach also depends on whether the patient has targets for immunotherapy or targeted therapies, leading to more diverse treatment options. While it was traditionally believed that surgery was always necessary for stage 3 lung cancer patients, this is no longer the case.
Professor Kim Tae-hwan of the Department of Hematology and Oncology at Ajou University Hospital emphasized during a segment on the Korean Society of Medical Oncology's YouTube channel (KSMO TV), stating, "Even for patients who are eligible for lung cancer surgery, those with EGFR mutations or ALK fusion mutations in stage 3 may not require surgery. Many of these patients can survive for extended periods with just oral targeted therapies."
(Credit: Getty Images)
(Credit: Getty Images)
Professor Kim further explained, "For stage 3 lung cancer, surgery is not always necessary. In cases where surgery is not an option, instead of opting for concurrent chemotherapy and radiation therapy, starting long-term targeted therapy for patients who are eligible is a very effective strategy."
Stage 3 NSCLC can present in various ways. The tumor may be large, and there may be metastasis to nearby lymph nodes, including those in the mediastinum, the central part of the body. Cancer cells can also spread to the lymph nodes under the collarbone and eventually to the neck.
The treatment strategy for stage 3 NSCLC is primarily determined through multidisciplinary consultation, with three main approaches. Professor Kang Eun-joo of the Department of Hematology and Oncology at Korea University Guro Hospital explained, "For stage 3 lung cancer, depending on the cancer situation, there are cases where surgery can be performed immediately, cases where surgery is not possible, and cases where reducing the tumor size may make surgery an option, so treatment methods vary."
Surgery is possible when there are only a few metastases, but it becomes unfeasible when there are multiple metastases. Professor Kang added, "The decision to proceed with surgery depends on the extent of the cancer, the patient’s lung function, and their overall health. If surgery is deemed feasible, it may be performed first, or chemotherapy or immunotherapy could be administered before surgery."
Professor Kim further explained, "When surgery is performed first, adjuvant chemotherapy is typically administered, and immunotherapy may also be added. For patients with mutations such as EGFR or ALK fusion, targeted therapy after surgery has shown good results, so these patients can receive oral targeted therapies post-surgery."
When surgery is not possible, Professor Kang clarified, "The standard treatment involves concurrent chemotherapy and radiation therapy. This combined therapy aims for a cure, with a high radiation dose and chemotherapy to maximize its effect."
Professor Kim explained, "For stage 3 NSCLC patients who cannot undergo surgery, the standard treatment is chemotherapy and radiation therapy, but this is not the end of treatment. Afterward, immunotherapy is commonly given for a year if PD-L1 expression is present. If PD-L1 is absent, treatment decisions are made based on the patient’s condition."
There is also the possibility of introducing new treatments for inoperable stage 3 lung cancer. Professor Kang noted, "Recent research has shown that for patients with EGFR mutations, maintaining EGFR targeted therapy after chemotherapy and radiation therapy leads to a longer survival period. Although this has not been approved yet, if it is approved in the future, maintaining targeted therapy after chemotherapy and radiation could become part of the treatment regimen."
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Kim Kyoung-Won kkw97@docdocdoc.co.kr
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