When considering adjuvant chemotherapy for resected lung cancer, do you treat rarer histologic patterns such as acinar or lepidic the same as you would a more typical NSCLC?

Quick answer:

Lepidic histology can affect the decision for adjuvant therapy.

Acinar histology does not affect the decision for adjuvant therapy.

Rationale:

Lepidic is the AIS component in minimally invasive or invasive adenocarcinomas.

Based on Travis', JTO 2016, recommendation not to use the noninvasive component in determining the T stage, the AJCC 8th edition only uses the solid component on CT and the invasive component on pathology as T descriptor.

There is however documented variability in quantifying noninvasive components.

The clinical T stage can be variable depending what imaging was used (i.e.,mediastinal or lung window for mixed lesions). IASLC recommends the lung window to determine the clinical T stage. The pathological determinati...