Dr. Park on Determining Treatment Approaches in NSCLC

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Henry S. Park, MD, MPH, discusses key considerations when selecting an optimal treatment approach for patients with stage II and III non–small cell lung cancer.

Henry S. Park, MD, MPH, associate professor, Therapeutic Radiology, Yale School of Medicine, vice chair, Clinical Research, Therapeutic Radiology, chief, Thoracic Radiotherapy Program, Therapeutic Radiology, Smilow Cancer Hospital, Yale Cancer Center, discusses key considerations when selecting an optimal treatment approach for patients with stage II and III non–small cell lung cancer (NSCLC).

Several key factors contribute to a patient's eligibility for surgical resection, Park begins. Pulmonary reserve function is crucial to consider, as some patients may experience worsened lung function after surgery. Patients must also be healthy enough to receive anesthesia and make it through the required recovery period without significant complications, Park says.

If a patient meets the criteria for surgical resection, clinicians must then determine if the patient would benefit from preoperative treatment with either systemic therapy or radiation therapy, Park continues. In cases where a patient should proceed directly to surgery, administering either option as adjuvant therapy may also be appropriate, he notes.

Tumor size may influence the use of neoadjuvant therapy, as enlarged tumors often require further shrinkage before a patient can proceed to surgery, Park says. Similarly, lymph node involvement is a strong prognostic factor in NSCLC, and measuring the presence, distribution, and number of lymph nodes may better direct the selection of patients for adjuvant therapy. The expression level of key biomarkers, such as PD-L1, can also indicate a patient's responsiveness to targeted therapies or immunotherapies, Park explains.

Ultimately, an individual's treatment approach should be decided by a multidisciplinary team of radiation, medical and surgical oncologists, Park states. These clinicians typically analyze a patient's imaging, pathology, and severity of disease at weekly tumor boards in order to gain a comprehensive understanding of a patient's unique case, Park concludes.

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