Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: searching the evidence to guide the decision

Abstract

Locally advanced non-small cell lung cancer (LA-NSCLC) is composed of heterogeneous subgroups that require a multidisciplinary team approach in order to ensure optimal therapy for each patient. Since 2010, the National Comprehensive Cancer Network has recommended chemoradiation therapy (CRT) for bulky mediastinal disease and surgical combination for those patients with single-station N2 involvement who respond to neoadjuvant therapy. According to lung cancer tumor boards, thoracic surgeons make a decision on the resectability of the tumor, if it is determined to be unresectable, concurrent CRT (CCRT) is considered the next choice. However, the survival benefit of CCRT over sequential CRT or radiotherapy alone carries the risk of additional toxicity. Considering severe adverse events that may lead to death, fit patients who are able to tolerate CCRT must be identified by multidisciplinary tumor board. Decelerated approaches, such as sequential CRT or high-dose radiation alone may be a valuable alternative for patients who are not eligible for CCRT. As a new treatment strategy, investigators are interested in the application of the innovative radiation techniques, trimodality therapy combining surgery after high-dose definitive CCRT, and the combination of radiation with targeted or immunotherapy agents. The updated results and on-going studies are thoroughly reviewed in this article.

Predictors of chemoradiotherapy versus single modality therapy and overall survival among patients with unresectable, stage III non-small cell lung cancer

“…Generally, patients who initiated cCRT were younger, had a better predicted PS score, and a lower CCI compared to patients who received single modality therapy. This is in line with prior research conducted by Oh et al (2017), which shows that cCRT is generally administered to healthier patients who are younger in age, and have minimal to no comorbidities, as well as the 2003 ASCO clinical practice guideline [17,28]. In this analysis, patients receiving cCRT had significantly better survival compared to patients receiving single modality therapy, which may be in part due to younger age and better predicted PS.…”

“…The administration of specialized multimodality therapy requires integrative knowledge on prognostic and predictive factors associated with survival in this patient population [17]. Ideally, these complex treatment decisions should be made by a multidisciplinary team (MDT) of physicians and care-givers in close coordination, as it has been shown that health outcomes improve for NSCLC patients when treatment is directed by an MDT [17,18].…”

Clinical outcomes of carbon‐ion radiotherapy for locally advanced non‐small‐cell lung cancer

“…For inoperable patients, in several studies, platinum‐based concurrent chemoradiotherapy was performed for patients with LA‐NSCLC, and the 2‐year high overall survival (OS) rate was approximately 50%‐60% . However, in contrast to its survival benefit, concurrent chemoradiotherapy induces severe hematologic toxicity, infection, esophagitis and pneumonitis; therefore, chemoradiotherapy is sometimes a heavy burden in elderly patients or patients with severe comorbidities . As an alternative treatment option, radiotherapy alone or low‐dose carboplatin‐based concurrent chemotherapy is sometimes introduced to patients, but such patients have a 2‐year OS rate of approximately 5%‐40%, with a poor prognosis …”

“…[3][4][5] However, in contrast to its survival benefit, concurrent chemoradiotherapy induces severe hematologic toxicity, infection, esophagitis and pneumonitis; therefore, chemoradiotherapy is sometimes a heavy burden in elderly patients or patients with severe comorbidities. [6][7][8] As an alternative treatment option, radiotherapy alone or low-dose carboplatin-based concurrent chemotherapy is sometimes introduced to patients, but such patients have a 2-year OS rate of approximately 5%-40%, with a poor prognosis. 9,10 Carbon-ion radiotherapy (CIRT) is a high linear energy transfer radiotherapy that is being widely used across Europe and Asia.…”

Perspectives for personalized therapy for patients with multidrug‐resistant tuberculosis

“…Other potentially fatal conditions, such a malignancies, are usually discussed by multidisciplinary specialist boards to provide optimal therapy for each individual from the start, including access to the most novel agents in the context of ongoing research projects aiming to continuously expand and improve the standard of treatment. Therapy for drug‐resistant TB is often initiated by nursing staff based on algorithms and limited information about the host and the pathogen .…”