PURPOSE: Stage IIIA NSCLC is defined largely by involved ipsilateral mediastinal nodes (N2). Extent of nodal disease has prognostic significance. Optimum management is unclear.
METHODS: In 2007 we conducted 5 live research events involving American medical oncologists to study planned management of stage IIIA (N2) lung cancer. 2 variant case scenarios were tested: 1) T1B NSCLC and a single enlarged 4R node on CT [path + by mediastinoscopy]; 2) T3 (< 2 cm from carina) bulky, multi-station, N2 disease [path +]. In each case no evidence of more advanced disease or physiologic contra-indications to curative therapy.
RESULTS: Scenario 1: 92% planned to include surgery (S): 39% S followed by (f/by) adjuvant therapy (adjRx), 20% induction chemotherapy (CT) f/by S f/by additional CT/radiation (RT); 42% induction CT/RT f/by S f/by additional CT. 8% planned CT/TRT (+ additional CT) without S. Differences by practice venue [academic/teaching hospital (A/T) vs. community practice (C’ity)]: A/T physicians: S F/by adjRx 47% vs 37% C’ity. Scenario 2: (bulkyN2), S f/by adjRx < 5%; 44% preferred to include S (12% CT /f/S; 32% CT/TRT f/by S) vs. 52% CT/TRT without S. A/T based MDs planned S [63% (including 42% CT/TRT f/by resection)] vs. CT/TRT alone (37%); C’ity 44% S (including 29% CT/TRT f/by S) and 59% CT/TRT. More S planned by MDs < 5 years out of training vs. more experience. Among MDs planning S in scenario #1, 44 - 51% planned S in scenario #2.
CONCLUSION: There is broad variation in management plans. Extent of disease (T status/N2 bulk) influences approach. S is frequent (92%; 48%) in both scenarios. The inclusion of S in both scenarios is > expected. Inclusion of S for bulky disease is more common in academic settings.
CLINICAL IMPLICATIONS: Lack of clear/convincing phase III data, physician/patient bias, and collaborative care may all impact planned treatment. Despite guidelines to the contrary, surgery remains a common treatment modality for stage III NSCLC. Better evidence based guidance in this setting is critical.
DISCLOSURE: Mark Green, University grant monies N/A; Grant monies (from sources other than industry) N/A; Grant monies (from industry related sources) N/A; Shareholder N/A; Employee Several of the authors work for NMCR Analytics in Atlanta GA. NMCR Analytics is a market research firm with full CASRO membership. NMCR Analytics receives payments from several pharmacuetical companies to do Oncology-related market research using a live, proprietary, case-based market research vehicle. As part of our market research, NMCR Analytics poses questions of academic interest to its research team. The materials reported herein were developed through the NMCR Analytics research vehicle. There was no direct funding from any pharmacuetical research partner in support of the research questions asked or the resulting data shown in this research abstract. All the data shown are the property of NMCR Analytics. The employees of NMCR listed as authors are full time salaried employees of NMCR Analytics and do not receive any funds directly from any pharmceutical research partner as part of NMCR Analtyics activities. Research data emerging from NMCR Analytics work have been accepted for presentation at the American Society of Clinical Oncology national meetings and in several peer reviewed journals; Consultant fee, speaker bureau, advisory committee, etc. N/A; Other N/A; No Product/Research Disclosure Information