The Multidisciplinary Care of Stage III NSCLC

Transcript: Nicolas Girard, MD: So stage III non—small cell lung cancer is defined as a tumor with a high size. Diameter of the tumor may be higher than 5 cm or associated with mediastinal lymph nodes. So we have lymph nodes called N2 lymph nodes, and we have also N3 lymph nodes that are…to the primary tumor. Those tumors are defined as being resectable or unresectable, and they actually depend on the surgical assessment and also the imaging that we have in our hand when making the decision about resectability. Obviously, there are tumors that are unresectable; for example, with invasion of the myocardium. Those tumors are clearly unresectable. And we have tumors that may be resectable, depending on the surgical assessment and the multidisciplinary discussion.

At Institut Curie and Institut Mutualiste Montsouris, we have a tumor board dedicated to thoracic oncology twice a week. We discuss all the patients with metastatic disease, early stage disease, but we spend a lot of time on the discussion of patient with stage III disease because of the multiple options that are available and the need for personalization of the treatment sequences. We have a radiologist who is attending to the multidisciplinary tumor board, and this is key to assess staging in the most accurate way. We have obviously surgeons, radiation oncologists, and medical oncologists. But we also have pathologists because we know that having a clear pathological diagnosis before discussing the treatment sequence is 1 of the keys in the management of stage III patients. We know also that we need now to have a PD-L1 status on the tumor in the setting of chemoradiotherapy followed by immunotherapy.

The selection of patients for chemoradiation is 1 key of the management of those patients. We need to have an accurate selection of the patient based on initial imaging, and that also includes systematic PET [positron emission tomography and] CT [computed tomography] to assess clearly what are the target lesions. Over the past 10 years, we also had an improvement in the radiation delivery techniques, including new devices that are called IMRT, intensity modulated radiation therapy, a better dose delivery to the tumor while sparing normal tissue from radiation. Clearly we have a good selection of the patient, of the tumors and also optimizing radiation delivery. Clearly, we have those 2 aspects and what is the most important thing actually for us is to have this close clinical follow-up of the patient all along during chemoradiation. Meaning a physician has to meet the patient at least every week during the delivery of radiation and also when delivering chemotherapy cycles.

Transcript Edited for Clarity