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July 27, 2023

What is perioperative therapy for early-stage lung cancer?

In Cancer Treatment, Lung Cancer

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Lung cancer can be a complex disease, and oncologists are finding that the best way to fight it involves more than one treatment. While surgery is a common way to treat early-stage lung cancer, fortifying surgery with other modes of therapy can lead to the best outcomes. And that’s where perioperative therapy for early-stage lung cancer comes in.

Perioperative therapy for early-stage lung cancer is systemic treatment — meaning that it affects the whole body — delivered before, after, or both before and after surgery. Basically, you can think of perioperative therapy for early-stage lung cancer as teaming up different cancer therapies in order to give the patient the best chance of beating the disease. The goal is to improve surgical or, less commonly, other local treatment outcomes like radiation to achieve the best long-term survival of patients. 

What is neoadjuvant therapy?

If the medical jargon is puzzling you, it’s helpful to know what oncologists mean when they talk about neoadjuvant therapy, which may be an element of perioperative treatment for early-stage lung cancer. 

Neoadjuvant therapy is a term used to describe treatment that happens before surgery. If you break the word down, you have “neo,” which suggests “new” or “before”, and “adjuvant,” which comes from the Greek word for “helping.” Here, the term refers to an early treatment to help the core treatment, which is usually surgery for patients with lung cancer who can safely undergo it.

Usually, neoadjuvant therapy for early-stage lung cancer involves a course of chemotherapy, often three to four months’ worth, often now along with immunotherapy — that is, treatment that harnesses the power of the body’s natural defenses — for two months. 


The benefit that patients get from neoadjuvant therapy is that treatment can begin early and finish quickly. It’s also possible that neoadjuvant therapy will shrink tumors, making the surgery for early-stage lung cancer less extensive. Oncologists can measure how the chemo or immunotherapy has affected the tumor, potentially using this information to help hone any further management recommendations to follow surgery.

What is adjuvant therapy?

If neoadjuvant therapy is meant to help the success of surgery for early-stage lung cancer by attacking tumors before the procedure, adjuvant therapy is the flip side of the perioperative therapy coin. The difference is that adjuvant therapy for early-stage lung cancer occurs after surgery is complete. In similar fashion, the goal is for more patients to live longer.
Patients facing early-stage lung cancer can receive any of the following as adjuvant therapy after their surgery:

  • Chemotherapy, usually lasting three months
  • Immunotherapy, lasting as long as one year, and generally given after any planned chemotherapy is completed
  • Targeted therapy, lasting as long as three years, in the case of early-stage lung cancer that tests positive for a mutation to the gene labeled EGFR; this is also typically given after post-operative chemotherapy 


Adjuvant therapy has a number of benefits in fighting early-stage lung cancer. 


The surgeon can perform the procedure to remove tumors earlier, which may be particularly valuable if the medical team and/or patient are concerned about getting to surgery without any new complications along the way. During recovery, patients can be tested for specific molecular markers that can guide doctors in choosing the most effective treatment. 


One potential challenge with adjuvant therapy is that patients may have difficulties with recovering from surgery and not be able, or simply not motivated, to pursue additional treatments after surgery has removed the cancer and there is no evidence of a cancer still to treat.  Patients tend to be more incentivized to accept the side effects of treatments when it is possible to get feedback on the cancer responding, as is possible before surgery, but not after surgery. 

Overall, adjuvant therapy for early-stage lung cancer gives the medical team the chance to personalize care based on the details of each patient’s disease — a strategy likely to offer the best results.

Why am I receiving other treatments in addition to surgery?

Perioperative therapy complements surgery by eliminating tumor cells that may be in the blood or other parts of the body. The underlying idea of perioperative therapy for early-stage lung cancer, whether before or after surgery, or both, is that delivering systemic treatment throughout the patient’s whole body could potentially fight tumor cells that may have gone undetected, too small to be identified on even the best scans.

How will I know whether perioperative therapy was successful?

After neoadjuvant therapy for early-stage lung cancer, doctors can review scans to see whether tumors have shrunk andexamine the resected tumor under a microscope to see what proportion of the cancer cells have died. 

After surgery, there is usually no visible evidence of cancer, so we rely on intermittent scans, typically done every few months and then with longer intervals after the first 1-2 years, that we hope will provide ongoing reassurance that there continues to be no evidence of cancer over time. In general, the longer the time since surgery that a patient’s scans show no cancer, the better the odds that the scans will continue to look favorable.

 

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