Stage 3 N2 Lung Cancer: A Multidisciplinary Therapeutic Conundrum

Abstract

Purpose of Review The treatment of stage III N2 non-small cell lung cancer (NSCLC) remains debated. There is an absence of a universally agreed definition of resectability for this heterogeneous group and a lack of trial data. Recent Findings We reviewed and compared current international guidelines and evidence surrounding management of stage III N2 NSCLC. The Irish and Australian guidelines advise subcategorising N2 disease into N2a (may be resectable) and N2b (never resectable). On the contrary, American and British guidelines avoid subcategorising N2 disease, emphasising importance of local MDT decisions. It is suggested that evidence for resection of stage III tumours is relatively weak, but that stage IIIA should generally be considered for resection, and stage IIIB is not recommended for resection. For resectable disease, surgery may be combined with neoadjuvant chemoimmunotherapy, or adjuvant chemotherapy followed by immunotherapy and radiotherapy in selected patients. Summary There is some evidence that technically resectable disease can be treated solely with radiotherapy with similar outcomes to resection. In the event of unresectable disease, chemoradiotherapy has been the traditional management option. However, recent studies with chemoradiotherapy alongside immunotherapy appear promising. There are many factors that influence the treatment pathway offered to patients with stage III N2 NSCLC, including patient factors, team expertise, and local resources. Therefore, the role of MDTs in defining resectability and formulating an individualised treatment plan is crucial.

A Single-Center Experience in Combined Oncological–Surgical Treatment for Resectable Locally Advanced Non-Small Cell Lung Cancer (NSCLC)

“…An advantage of this multidisciplinary committee approach is recognized through its numerous members' expertise in each field [31]. In addition, the medical professional specialists have experience and knowledge of the patient condition along the duration of the protocols' steps and follow-up, which contributes to the best standard of care [31,32]. One of the roles of the tumor board multidisciplinary committee is to consider the possible risks related to the diverse therapies such as toxicity adverse events of chemotherapy, radiotherapy, and immunotherapy [32].…”

“…In addition, the medical professional specialists have experience and knowledge of the patient condition along the duration of the protocols' steps and follow-up, which contributes to the best standard of care [31,32]. One of the roles of the tumor board multidisciplinary committee is to consider the possible risks related to the diverse therapies such as toxicity adverse events of chemotherapy, radiotherapy, and immunotherapy [32]. The added value of the committee meetings is the sharing of knowledge for the sake of the patients' benefit.…”