Regional Perspectives Influence Treatment Options for Lung, Esophageal Cancers

The complex process of determining cancer stages requires accurate decision-making within the context of an interdisciplinary team. But standard general thoracic and esophageal diagnosis and treatment practices can vary due to a lack of uniformity between European and US practice guidelines.

ESTS @ STS: Controversial Issues in General Thoracic Surgery — Perspectives From Europe and North America


7:15 a.m. – 9:15 a.m.

Room 30ABCD

Mediastinal staging for clinical stage 1 non–small-cell lung cancer (NSCLC) is one example. Survival of all NSCLC patients is disappointing, with a 5-year survival of 18%. Accurate staging is crucial because it determines the choice of treatment and prognosis. 

“There’s a debate between European and North American surgeons about how extensive the staging should be,” said Michael J. Weyant, MD, of the University of Colorado in Aurora. 

Michael J. Weyant, MD

Michael J. Weyant, MD

Those differences will be highlighted during Monday morning’s collaborative session from STS and the European Society of Thoracic Surgeons. Dr. Weyant and Gilbert Massard, MD, PhD, of the Centre Hospitalier in Strasbourg, France, will co-moderate the session that will feature experts from Belgium and the United States describing and debating best practices. 

“Presenting both the European and North American perspectives will help us realize that even though we all view ourselves as modern, state-of-the-art thoracic surgery specialists, there are cultural differences that impact how lung and esophageal cancers are treated,” Dr. Weyant said. “Part of it is based on societal resources, and part of it is based on how patients in different geographic areas perceive invasive treatments for cancer.” 

Also during the session, experts from the United Kingdom and the United States will present their respective viewpoints on using mediastinal staging to select clinical stage IIIAN2 NSCLC lung cancer patients as candidates for surgery after induction therapy. Speakers also will offer insights on the role of induction therapy for select groups of patients with cT2N0 esophageal cancer. 

 “There is a continuing debate over whether those patients should get chemotherapy and radiation therapy prior to surgery,” Dr. Weyant said. 

Both the European and North American approaches to diagnosis, staging, and multimodal treatment have merit. But by exploring the geographic vantage points in treatment strategies, surgeons from both sides of the Atlantic may come away with different ways of doing things to optimize patient outcomes. 

“Surgeons might see an acceptable treatment pathway presented that they might use in a subsegment of their patients they hadn’t considered before,” Dr. Weyant said.