Multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer

Abstract

Stage III non-small cell lung cancer (NSCLC) is a very heterogeneous disease that encompasses patients with resected, potentially resectable and unresectable tumours. To improve the prognostic capacity of the TNM classification, it has been agreed to divide stage III into sub-stages IIIA, IIIB and IIIC that have very different 5-year survival rates (36, 26 and 13%, respectively). Currently, it is considered that both staging and optimal treatment of stage III NSCLC requires the joint work of a multidisciplinary team of expert physicians within the tumour committee. To improve the care of patients with stage III NSCLC, different scientific societies involved in the diagnosis and treatment of this disease have agreed to issue a series of recommendations that can contribute to homogenise the management of this disease, and ultimately to improve patient care.

Real‐world outcomes of chemoradiotherapy for unresectable Stage III non‐small cell lung cancer: The SOLUTION study

“…1 About 30% of patients with non-small cell lung cancer (NSCLC) present with Stage III disease, of which less than a third survive for longer than 5 years. 2 Concurrent chemoradiotherapy (cCRT) with a curative intent is currently the standard treatment approach for unresectable Stage III NSCLC, and is recommended in the National Comprehensive Cancer Network (NCCN), 3 European Society for Medical Oncology, 4 a multidisciplinary consensus statement, 2 and Japanese 5 clinical guidelines. According to the Japanese guidelines, 5 there is sufficient evidence from clinical trials to support the use of cisplatin + docetaxel and carboplatin + paclitaxel for the treatment of Japanese NSCLC patients.…”

Prognostic value of the common tumour-infiltrating lymphocyte subtypes for patients with non-small cell lung cancer: A meta-analysis

“…Due to the lack of sensitive measures to evaluate the prognosis of NSCLC, treatment methods cannot be enacted in a timely manner, which leads to 60% of patients with locally advanced NSCLC experiencing relapse after therapy or dying of metastasis [4]. Although multidisciplinary synthetic therapy has been used to treat patients with NSCLC, the survival rate of patients with NSCLC has barely improved over recent years [5]. At present, the prognosis of patients with NSCLC was forecasted on the basis of TNM staging based on histopathology or imageology, and this method has been proved that it is not precise by growing evidence [6].…”

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer

“…Nuclear medicine plays an important role in the management of lung cancer; [102][103][104][105][106] there is evidence of the efficacy of 18 F-FDG PET/CT in selected clinical indications.…”

“…Single PET-positive distant lesions need pathological confirmation [102][103][104][105]. • Initial staging of patients with locally advanced NSCLC: ESMO guidelines state that all patients planned for definitive stage III NSCLC treatment should undergo a diagnostic thin section CT followed by 18 F-FDG PET/CT with a CT technique with adequately high resolution for initial staging to rule out detectable extra-thoracic extra-cranial metastasis and to assess potential mediastinal lymph node involvement, ideally within 4 weeks before the start of treatment.…”

“…• Initial staging of patients with locally advanced NSCLC: ESMO guidelines state that all patients planned for definitive stage III NSCLC treatment should undergo a diagnostic thin section CT followed by 18 F-FDG PET/CT with a CT technique with adequately high resolution for initial staging to rule out detectable extra-thoracic extra-cranial metastasis and to assess potential mediastinal lymph node involvement, ideally within 4 weeks before the start of treatment. Single PET-positive distant lesions need pathological confirmation [105,107]. • NSCLC treatment: PET/CT is recommended to guide target volume delineation in preparation for curative-intent radiotherapy or chemoradiotherapy in patients with NSCLC; a diagnostic CT scan with intravenous iodine contrast (unless contra-indicated) and diagnostic whole body 18 F-FDG PET/CT are considered mandatory.…”