Expert panel offers insight on new international lung cancer classifications

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The newly implemented International Staging Classification System for Lung Cancer helps evaluate the prognosis and treatment selection for patients diagnosed with lung cancer, according to last week's Web cast presented by The International Association for the Study of Lung Cancer (IASLC), in response to its  "Staging Manual in Thoracic Oncology," released in the 7th Edition of TNM in Lung and Pleural Tumours in August.

The Web cast, which featured a round-table discussion and presentation by three lung cancer luminaries on the updated guidelines, offered an overview of the new classifications, management implications and what the new staging system will mean for lung cancer patients globally.

Peter Goldstraw, MD, consultant thoracic surgeon with Royal Brompton Hospital and professor of thoracic surgery at Imperial College in London, opened the presentation with a description of the staging classifications and how they were developed.

Goldstraw noted that size cut points were one of the largest factors in determining staging. However, he further emphasized that the size cut points were not chosen at random, but based on research determining that the aforementioned cut points had been proven as separating patients with different prognoses.

“We performed an analysis using size as a continuous variable and these were the cut points that came out as having the greatest statistical significance,” Goldstraw said.

The management implications in response to the new staging classifications were presented by Frank C. Detterbeck, MD, professor and chief of thoracic surgery and surgical director of the Yale Thoracic Oncology Program in Hamden, Conn.

Detterbeck expressed satisfaction with the new guidelines and explained that subsequent staging was based on intuition, rather than statistical validity.

“The classification is a nomenclature,” said Detterbeck. “It allows us to consistently describe tumors, which is very important because if we were going to talk with one another, compare results from different centers, parts of the globe and different clinical trials, we have to have an accurate way of taking patients and grouping them into groups that make sense.”

The classification system was a result of international collaboration, said Detterbeck, who believes that the new system has laid the foundation for further international collaboration among experts in the field of lung cancer study.

“It’s taken over 10 years, but it really moved the field forward quite dramatically,” Detterbeck said.

Despite satisfaction with the staging system, Detterbeck stressed that the potential danger of the staging guidelines is to utilize them as a shortcut to treatment selection–a “misuse” of the system.

Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation in Liverpool, England, took a patient advocate stance during her potion of the presentation.

For millions of lung cancer patients worldwide, Fox explained, the new system is "crucial" in regards to the choice of treatment options, which could potentially lead to the best chance of survival and quality of life.

“The new staging options, being based on more up-to-date information, should mean more appropriate grouping of patients into clinical trails, [and] ultimately, this may mean a different treatment approach in the future,” Fox said.

Additionally, Fox noted future implications for lung cancer patients. “Patients and their peers are becoming more informed about their disease and about its management," she said. "The staging classifications offer them [a more] easily accessible information source.”

Supported by the International Union against Cancer and the American Joint Committee on Cancer, the revised guidelines serve as the first updates made to lung cancer staging within the past 12 years.