Treatment options for regional lung cancer 2022
Treatment options for regional lung cancer 2022
Regional lung cancer, stage III lung cancer and locally advanced lung cancer are three terms that are usually used interchangeably by lung cancer specialists to describe the spread of the lung cancer lymph nodes (to the central chest, neck or the other side of the chest) or disease in contact with a major structure.
The treatment options for regional lung cancer has evolved considerably in the last few years but usually involves multi-modality treatments. Traditionally chemotherapy, radiotherapy and possibly surgery would be recommended.
Relatively new treatments such as immunotherapy, has redefined how we approach treatment options for regional lung cancer, which is now divided into two groups: those in whom surgery is likely to successfully remove all the disease and those in whom surgery would not. This is usually reviewed and decided by a tumour board [or multi-disciplinary team] and recommendations are made to you.
Surgically “resectable” disease
Your scans are usually reviewed by a surgeon(s) to determine if there is a good chance that all the cancer can be removed, and if this is the case, then the treatment option in this setting is three treatments consisting of chemo-radiotherapy followed by surgery [this recommendation is made by 2022 US NCCN guidelines and 2019 UK NICE guidelines].[1][2] There is also the option of two combination treatments surgery and chemotherapy or chemo-radiotherapy alone, both of which achieve similar outcomes in terms of prolonging life (which is estimated to be slightly less then three treatments).[3]
Surgically “unresectable” disease
If surgeon(s) have reviewed your scans and decided that the cancer is unlikely to be completely removed by surgery, then chemo-radiotherapy followed by immunotherapy is usually recommended as the treatment of choice.[4]
Future developments
Currently there are a large number of studies that are investigating the combination of surgery and immunotherapy for those in whom their cancers that are considered resectable, as well as new systemic anti-cancer treatment options for those in whom their cancers are not.
The author of the article Professor Eric Lim has received consultancy fees and/or project grants from AstraZeneca (who manufacture durvalumab).
1. NCCN Clinical Practice Guidelines in Oncology. Non-small cell lung cancer Versions 1.2022
2. National Institute of Clinical Excellence. Lung cancer: diagnosis and management. Clinical guideline [NG122]. 2019.
3. McElnay PJ, Choong A, Jordan E, Song F and Lim E. Outcome of surgery versus radiotherapy after induction treatment in patients with N2 disease: systematic review and meta-analysis of randomised trials. Thorax. 2015;70:764-8.
4. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, Kurata T, Chiappori A, Lee KH, de Wit M, Cho BC, Bourhaba M, Quantin X, Tokito T, Mekhail T, Planchard D, Kim Y-C, Karapetis CS, Hiret S, Ostoros G, Kubota K, Gray JE, Paz-Ares L, de Castro Carpeño J, Faivre-Finn C, Reck M, Vansteenkiste J, Spigel DR, Wadsworth C, Melillo G, Taboada M, Dennis PA and Özgüroğlu M. Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC. New England Journal of Medicine. 2018;379:2342-2350.
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