Stage 3 N2 lung cancer: A multidisciplinary therapeutic conundrum

Journal article


Lily Carter, Vedika Apte, Arushi Shukla, Aruni Ghose, Raj Mamidi, Alexandra Petohazi, Shania Makker, Soirindhri Banerjee, Stergios Boussios and Giuseppe L. Banna 2024. Stage 3 N2 lung cancer: A multidisciplinary therapeutic conundrum. Current Oncology Reports. 26, pp. 65-79.
AuthorsLily Carter, Vedika Apte, Arushi Shukla, Aruni Ghose, Raj Mamidi, Alexandra Petohazi, Shania Makker, Soirindhri Banerjee, Stergios Boussios and Giuseppe L. Banna
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.

KeywordsNon-small cell; Lung cancer; Neoadjuvant; Resectable; Immunotherapy; Radiotherapy; Chemotherapy
Year2024
JournalCurrent Oncology Reports
Journal citation26, pp. 65-79
PublisherSpringer
ISSN1523-3790
1534-6269
Official URLhttps://link.springer.com/article/10.1007/s11912-023-01486-2#article-info
Publication dates
Online02 Jan 2024
Publication process dates
Accepted15 Dec 2023
Deposited21 Feb 2024
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Open
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