Radiation for Patients With Stage 3 Non-Small Cell Lung Cancer
Sameera Kumar, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania, highlights the role radiation plays in the treatment of patients with stage 3 non-small cell lung cancer (NSCLC).
Dr Jamie Chaft makes the opposing argument here.
Transcript:
Hello, my name is Sameera Kumar, and I am a radiation oncologist from the Fox Chase Cancer Center at Great Debates in Solid Tumors. I debated for the use of radiation in stage 3 non-small cell lung cancer. I believe that surgery, systemic therapy, and radiation are all actually different tools we can use in different situations and just like building a bench, or a shelf, or a chair some projects call for some tools and not others and sometimes you combine the use of tools into 1 project.
In my debate, I covered some data from the past including data from SWOG-8805 and Intergroup 0139 and the lessons they taught us, and the lessons include things like it's very important to clear the mediastinum and perhaps patients that need more complex surgeries do more poorly. I talked about how some of these lessons lead into what we know now about neoadjuvant therapy and then resectable disease but also, they teach us about unresectable disease as well.
I covered very broadly because there's a lot of contention on what constitutes unresectable versus resectable disease and I talked a little bit about how the goal of resection is to get negative margins, but that's really where the border lies between resectable and unresectable, whether that includes multi-station N2, whether that includes even N3 or bulky diseases, is currently surgeon- and institution-specific. Regarding the unresectable data, I went over the data that we got from the PACIFIC trial, the LAURA trial and how it impacts EGFR patients, and I also talked about some new data from PACIFIC-2.
All in all, in my practice, I believe that the key is patient selection. You need to pick the appropriate patients to go to surgery and when you're treating them with neoadjuvant therapy, you need to make sure that they can reasonably go on to surgery because treating them with neoadjuvant therapy followed by chemoradiation or radiation alone isn't really an established standard of care. In those borderline patients, perhaps the better thing to do is to place them on a clinical trial dealing with borderline patients or to just treat them with chemoradiation.
Source:
Kumar S. Optimizing therapeutic outcomes in stage 3 lung cancer: Radiation. Presented at Great Debates in Solid Tumors. March 22-23, 2025; New York, NY.
