RH1970 Posted September 3, 2020 Share Posted September 3, 2020 I'm a little confused about whether curative surgery is an option for stage iii lung cancer? If I'm looking at the NCCN guidelines, surgery as a primary treatment is listed as an option for stage iii (N0 or N1), but for N2 it reads 'Not Many'. Then I wonder if surgery can become an option for stage iii after neo-adjuvant chemo or chemo-radiation. Or is this determined on an individual basis beyond the guidelines. Can anyone clear this up for me? Thanks. -Rick Link to comment Share on other sites More sharing options...
Rower Michelle Posted September 3, 2020 Share Posted September 3, 2020 Hi Rick- You’re instinct is correct, Stage III is very much individualized, surgery is even becoming an option for Stage IV. That’s why second opinions are really important because of the variability. A friend of mind was a surgical candidate with a targetable mutation. She got a third opinion that recommended an 8 week trial of targeted therapy, surgery, chemo/radiation followed by targeted therapy. Totally not in the NCCN guidelines but the treatment plan was developed by an expert at a CCC. After 8 weeks of targeted therapy the tumor was gone which negated the need for surgery. Chemo/radiation followed with maintenance targeted therapy. She’s had a full and complete remission. Another friend of mine had two cycles of chemo to reduce the tumor size, then had surgery followed by concurrent chemotherapy/radiation & immunotherapy. Dr Heather Wakelee said in a Go2Foundation Living Room that there is little consensus among oncologists on how to best treat Stage III which I think is actually good news because it allows the doctor to have more options. Link to comment Share on other sites More sharing options...
Tom Galli Posted September 3, 2020 Share Posted September 3, 2020 Rick, I had a pneumonectomy (right lung removed) after pre-surgical chemo and radiation. My staging was confused. I had one tumor (in the main stem bronchus of my right lung) but it was very large. So my diagnosis was either a Stage IIIA or IIIB depending on how the size of the tumor was evaluated. But my course of treatment did in fact shrink the tumor and permit surgery. The downside to pretreatment—suture healing and that caused me to endure surgical mayhem of two more major surgeries and 3 tracheal stent procedures. Stay the course. Tom Link to comment Share on other sites More sharing options...
Barb1260 Posted September 12, 2020 Share Posted September 12, 2020 I was 3b and couldn’t have surgery because of location of the tumor. Chemo radiation and immunotherapy, and now just playing the wait and see game. Not sure if I would have gotten surgery if I could have it. Link to comment Share on other sites More sharing options...
RH1970 Posted September 12, 2020 Author Share Posted September 12, 2020 Thanks Barb, How are you doing on the chemo-radiation/immunotherapy course? Has it shown progress for you? Out of curiosity, did you have biomarker tests for mutations? -Rick Link to comment Share on other sites More sharing options...
Barb1260 Posted September 12, 2020 Share Posted September 12, 2020 Hi Rick. I completed my last dose of Imfinzi on May 7th. Chemo and radiation were done February 2019. I didn’t have all the biomarker testing. They did the PDL testing and that showed 90% expression so they knew I was a good candidate for immunotherapy. So far the CT scan in July was good. I’m appealing my PET scan denial so hopefully I can get one to get the current SUV if any. but doc said she thinks all I have is scar tissue since the radiation and chemo. Link to comment Share on other sites More sharing options...
RH1970 Posted September 12, 2020 Author Share Posted September 12, 2020 It sounds like it's working. That's good. Why would a PET scan be denied. Isn't that essential for monitoring a treatment's success? Strange. -Rick Link to comment Share on other sites More sharing options...
Barb1260 Posted September 12, 2020 Share Posted September 12, 2020 You would think that. They don’t want to pay unless something new is found. I got Not Medically necessary during treatment and Not in Treatment after completion as reasons which makes no sense which is one of my reasons for appealing. Insurance company has a 3rd party who precertifies. Thanks to Michelle on here, I investigated and found interesting information about the docs who wrote the denials. Basically the company pays the docs to deny, deny, deny. One of the docs was an OB/GYN with no oncology experience or training. Complaint also filed with the GA insurance commission. Link to comment Share on other sites More sharing options...
Jennedy Posted September 12, 2020 Share Posted September 12, 2020 I hate that you have to fight to get coverage when you are already fighting the disease. Link to comment Share on other sites More sharing options...
Barb1260 Posted September 12, 2020 Share Posted September 12, 2020 And that people who have no coverage, pay no taxes, are not citizens are getting everything for free-this is personal experience in the cancer Center I go through and it pisses me off. Link to comment Share on other sites More sharing options...
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