Staging and Resectability in NSCLC

Considerations for Evaluating Resectability in Stage III NSCLC

Resectability is typically correlated with stage1-3; however, because stage III NSCLC encompasses a wide range of disease characteristics, determining resectability may require a detailed medical and clinical evaluation of each individual patient’s case.1,3

 

NSCLC stage III resectability
NSCLC stage III resectability

 

Most patients with stage III NSCLC have unresectable tumors4,*

Most patients with stage III NSCLC have unresectable tumors4,*

 

NSCLC stage IIIA resectability
NSCLC stage IIIA resectability

 

Stage IIIA

N = 27,899

 

NSCLC stage IIIB resectability
NSCLC stage IIIB resectability

 

Stage IIIB

N = 13,448

 

*Based on National Oncology Data Alliance longitudinal patient data. Staging was based on the AJCC Cancer Staging Manual, 7th Edition of TNM Classification.

 

 

Nodal involvement predicts resectability of stage III NSCLC3,6

Due to the heterogeneity of nodal involvement in stage III NSCLC, in-depth nodal assessment is critical for determining resectability.1,3

 

Resectability by nodal status
Resectability by nodal status

 

Decisions regarding resectability should be evaluated within a multidisciplinary team and should consider whether or not3,6,8:

 

Nodes are bulky (>2 cm)

Tumor has spread beyond the nodal capsule

There is multistation nodal disease

Pathologic staging is crucial to determine the extent of nodal involvement.9 Learn more.

 

Evaluating patient characteristics can help estimate the risk associated with surgical resection1,5 

When deciding a treatment path, consider the patient’s1,5:

 

NSCLC patient performance status
NSCLC patient performance status

 

Performance status1

NSCLC patient comorbidities
NSCLC patient comorbidities

 

Comorbidities5

NSCLC patient lung function
NSCLC patient lung function

 

Lung function1,5

NSCLC patient age
NSCLC patient age

 

Age5

 

Performance status1

 

 

Comorbidities5

 

 

Lung function1,5

 

Age5

 

Common comorbidities for NSCLC include diabetes mellitus, COPD, cardiovascular disease, and cerebrovascular disorders10

Multidisciplinary team collaboration

For patients with N2 nodal involvement, guidelines recommend multidisciplinary team evaluation to discuss treatment plans, including1,7:

 

Radiation oncologists
Radiation oncologists

 

Radiation oncologists

Thoracic surgeons
Thoracic surgeons

 

Thoracic surgeons

Pulmonologists
Pulmonologists

 

Pulmonologists

Medical oncologists
Medical oncologists

 

Medical oncologists

 

Radiation oncologists

 

Thoracic surgeons

 

Pulmonologists

 

Medical oncologists

In-depth assessment of nodal involvement and patient characteristics is critical for accurate resectability assessment.1,3,5,6

AJCC, American Joint Committee on Cancer; COPD, chronic obstructive pulmonary disease; NCCN, National Comprehensive Cancer Network; NSCLC, non–small cell lung cancer.

 

References: 1. Detterbeck FC et al. Chest. 2013;143(5)(suppl):7S-37S. 2. Silvestri GA et al. Chest. 2013;143(5)(suppl):e211S-e250S. 3. Quint LE. Cancer Imaging. 2003;4(1):15-18. 4. Kantar Health CancerMPact. http://cancermpact.khapps.com. Accessed April 20, 2018. 5. Lembicz M et al. Ann Thorac Med. 2018;13(2):101-107. 6. Balmanoukian A et al. Oncology (Williston Park). 2010;24(3):234-241. 7. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non–Small Cell Lung Cancer V4.2019 .© National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed April 29, 2019. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. To view the most recent and complete version of the guideline, go online to NCCN.org. 8. Martins RG et al. J Natl Compr Canc Netw. 2012;10(5):599-613. 9. Steinfort DP et al. Medicine (Baltimore). 2016;95(8):e2488. 10. Dutkowska AE et al. Pneumonol Alergol Pol. 2016;84:186-192.