Dr Lin on the Effect of Perioperative Treatment on Surgical Approaches in NSCLC

Jules Lin, MD, professor, surgical oncologist, Section of Thoracic Surgery, surgical director, Lung Transplant Program, Rogel Cancer Center, University of Michigan Health, discusses how approaches to surgical intervention in non–small cell lung cancer (NSCLC) may have shifted with the increasing use of targeted therapy and immunotherapies in the adjuvant and neoadjuvant setting.

The overall approach to surgical intervention for patients with NSCLC who have been treated with perioperative therapy has not substantially changed with the advent of neoadjuvant and adjuvant therapy, Lin begins. Many patients who have previously received neoadjuvant chemoradiation therapy are still eligible to be considered for minimally invasive surgery, Lin states, adding that the intervention could be thoracoscopic or robotic. However, there are several key factors to consider when determining the optimal management strategy for these patients, Lin emphasizes. These include the timing of surgery following radiation and the choice of perioperative treatment, he details.

For example, radiation therapy, which is a common component of neoadjuvant treatment, can lead to scarring and fibrosis in the affected tissues, Lin explains. Although minimally invasive surgery remains a viable option for a subset of these patients, there may be instances where the fibrosis is too extensive, Lin notes. In this scenario, conversion to an open thoracotomy may be necessary, Lin says.

Furthermore, certain targeted therapies and immunotherapies that are commonly utilized in perioperative treatment strategies can result in lymph node enlargement, as well as fibrosis and scarring in the thoracic region, Lin continues. This underscores the importance of active involvement by surgeons in the design of clinical trials, Lin says, as well as the interpretation of subsequent trial outcomes. Ultimately, collaboration between medical oncologists and surgeons is paramount in determining the most appropriate treatment strategy for patients in this space, Lin concludes.