Treatment for Stage IIIA Non-small Cell Lung Cancer (NSCLC)
My 69-year-old mother-in-law was recently diagnosed with Stage IIIA (T3N1) non-small cell lung cancer. She also has emphysema with low lung volume but very good lung function. She is going to undergo 3-4 weeks of chemo (taxol and carboplatin once a week) plus daily radiation therapy treatments. The thoracic surgeon will then perform surgery. She has undergone a lung biopsy with CT scan, MRI of the chest, abdomen, and brain, a PET scan, mediastinoscopy, and bronchoscopy. The surgeon is a thoracic surgeon with a specialty in lung cancer. My questions are (1) is the above treatment considered appropriate, (2) is a second opinion necessary, (3) how do we determine if the surgeon is good, and (4) will the emphysema cause substantial problems in her recovery? Any advice would be greatly appreciated.
Joseph B. Shrager, MD, Thoracic Surgeon, responds:
From the information you have provided, it sounds as though the treatment, which has been embarked upon, is appropriate, although I cannot be sure without seeing your mother-in-law and her films personally. I do not know what structure the tumor is invading to make it T3, but with invasion of most structures except simple chest wall/rib invasion, many would give chemotherapy with or without radiation therapy preoperatively, while some would simply go ahead and perform the surgery first, and then give chemotherapy with or without radiation therapy after surgery. The metastatic workup, including mediastinoscopy, was very appropriate for any patient being considered for surgery and suggests that the surgeon has a deep experience with lung cancer.
In general, you would like a surgeon with a special interest in lung cancer - – such individuals usually identify themselves as "General Thoracic Surgeons" or "non-cardiac thoracic surgeons" – as opposed to a cardiac surgeon or a general surgery who occasional performs lung cancer surgeries. You might find out if the surgeon is primarily a thoracic surgeon to get at this issue. I do not have enough information about your mother-in-law's degree of emphysema to determine how it will affect her recovery, but it may affect her risks and recovery significantly, depending on how severe it is as measured by a variety of preoperative tests, including pulmonary function testing. I hope this is of help to you.