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Stage 3 N2 lung cancer: A multidisciplinary therapeutic conundrum

Carter, Lily, Apte, Vedika, Shukla, Arushi, Ghose, Aruni, Mamidi, Raj, Petohazi, Alexandra, Makker, Shania, Banerjee, Soirindhri, Boussios, Stergios, Banna, Giuseppe L and others. (2024) Stage 3 N2 lung cancer: A multidisciplinary therapeutic conundrum. Current Oncology Reports, 26 (1). pp. 65-79. ISSN 1523-3790. (doi:10.1007/s11912-023-01486-2) (KAR id:104655)


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. 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. 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.

Item Type: Article
DOI/Identification number: 10.1007/s11912-023-01486-2
Uncontrolled keywords: Chemotherapy, resectable, non-small cell, neoadjuvant, lung cancer, radiotherapy, immunotherapy
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
SWORD Depositor: JISC Publications Router
Depositing User: JISC Publications Router
Date Deposited: 19 Jan 2024 11:38 UTC
Last Modified: 12 Feb 2024 12:29 UTC
Resource URI: (The current URI for this page, for reference purposes)

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