Early Stage Lung Cancer Treatment
I am a 49-yr-old white male in excellent health with a 35 pack-year history of smoking and a family history of lung cancer (father). I noticed blood in my sputum 5 weeks ago (the day I quit smoking). Three days later, I was told a CT scan revealed a mass in my lung. I since had a thoracotomy (of the right upper lobe) performed without complications. According to the surgeon, the pathology report after surgery indicated the tumor was 3.4 cm in size but the margins were !0very, very good.!1 He also told me 3 lymph nodes were extracted and all were clear of cancer. Both my surgeon and pulmonologist have indicated that the pathology report was so good that I do not need to see an oncologist. I have another meeting with my family physician this week, but none of my doctors are discussing follow-up actions, and they are giving me the impression that they view me as cured. What would you recommend for follow-up protocols in my case? What tests should be performed and how often? Should I at least consult with an oncologist? Should I inquire about adjuvant chemotherapy?
Charles B. Simone II, MD, Radiation Oncologist at Penn Medicine, responds:
Given the increasing data on a survival improvement in early stage lung cancer with surgical resection AND adjuvant chemotherapy, you should at least consult with an oncologist and review the risks and benefits of chemotherapy. Based on your pathology report, it sounds like you have a T2aN0M0 tumor, which would be a stage IB. There have now been 3 studies (performed by The International Adjuvant Lung Cancer Trial Collaborative Group, the National Cancer Institute of Canada Clinical Trials Group and the National Cancer Institute of the United States Intergroup, and the Cancer and Leukemia Group B) of adjuvant chemotherapy in this setting, and they all suggest between a 5-15% improvement in 5-year survival with chemotherapy, compared to surgery alone. However, the benefit of chemotherapy appears mostly limited to patients who have primary tumors >4 cm in maximum dimension or who have tumors that otherwise invade into adjacent structures. While chemotherapy may benefit some patients with tumors smaller than 4 cm, often times the toxicities of the therapy are greater than the potential benefits for these patients. If you do not receive adjuvant chemotherapy, you should continue to follow-up with your thoracic surgeon and undergo imaging, likely with CT scans, every 3-6 months for the first 2 years after surgery.