The Role of Surgery in Locally Advanced NSCLC

Jessica S. Donington, MD, discusses the role of surgery in managing patients with locally advanced NSCLC.


Jessica Donington, MD:  I'm Jessica Donington, I'm a thoracic surgeon. I'm actually the chief of thoracic surgery and professor at the University of Chicago. I spoke today at the Perspectives of Thoracic Oncology Meeting on the role of surgery in 3A.

The role of surgery is pretty controversial in 3A lung cancer, it's definitely not an area where all of the ins and outs, do's and don'ts have been worked out, and therefore it's one of the areas I really like both for research, and education, and to talk about because I don't have to come up with any big answers, because all I have to do is present a lot of good arguments.

The take‑home of my talk was that I do believe surgery has an important role in 3A, and that we still need to continue to do trials to address things like what is the best induction strategy, can we include radiation, and how to do that safely. I definitely think right now in 2019 the area of most exciting research is the use of induction immunotherapies, not only for resectable 3A but for stage 2 and 3A disease.

That combination of putting stage 2, non‑N2 3A, and N2‑positive 3A patients all in a cohort where they're eligible for these trials has really changed the outlook of surgery and trial recruitment. We have been able to recruit very aggressively to these trials, and the initial responses have been very good.

We are seeing major pathologic response rates, higher than we have seen before. These induction strategies appear to be safe without delays to surgery or increased morbidity and mortality related to surgery. That being said, surgery for stage 3 is complicated.

Surgeons need to go into it with a little more careful view with each operation, as there could be scarring and fibrosis in the mediastinum, we talked a little bit about how to conduct a careful operation in the setting of 3A disease.

In general, my take‑home message is that surgery continues to play a very important role here, and I think that role will grow. That induction therapies are very important, and that the area is changing dramatically.

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