Stage III N2 non-small cell lung cancer treatment: decision-making among surgeons and radiation oncologists.

Glatzer, Markus; Leskow, Pawel; Caparrotti, Francesca; Elicin, Olgun; Furrer, Markus; Gambazzi, Franco; Dutly, André; Gelpke, Hans; Guckenberger, Matthias; Heuberger, Jürg; Inderbitzi, Rolf; Cafarotti, Stefano; Karenovics, Wolfram; Kestenholz, Peter; Kocher, Gregor Jan; Kraxner, Peter; Krueger, Thorsten; Martucci, Francesco; Oehler, Christoph; Ozsahin, Mahmut; ... (2021). Stage III N2 non-small cell lung cancer treatment: decision-making among surgeons and radiation oncologists. Translational lung cancer research, 10(4), pp. 1960-1968. AME Publishing 10.21037/tlcr-20-1210

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Background

Stage III N2 non-small cell lung cancer (NSCLC) is a very heterogeneous disease associated with a poor prognosis. A number of therapeutic options are available for patients with Stage III N2 NSCLC, including surgery [with neoadjuvant or adjuvant chemotherapy (CTx)/neoadjuvant chemoradiotherapy (CRT)] or CRT potentially followed by adjuvant immunotherapy. We have no clear evidence demonstrating a significant survival benefit for either of these approaches, the selection between treatments is not always straightforward and can come down to physician and patient preference. The very heterogeneous definition of resectability of N2 disease makes the decision-making process even more complex.

Methods

We evaluated the treatment strategies for preoperatively diagnosed stage III cN2 NSCLC among Swiss thoracic surgeons and radiation oncologists. Treatment strategies were converted into decision trees and analysed for consensus and discrepancies. We analysed factors relevant to decision-making within these recommendations.

Results

For resectable "non-bulky" mediastinal lymph node involvement, there was a trend towards surgery. Numerous participants recommend a surgical approach outside existing guidelines as long as the disease was resectable, even in multilevel N2. With increasing extent of mediastinal nodal disease, multimodal treatment based on radiotherapy was more common.

Conclusions

Both, surgery- or radiotherapy-based treatment regimens are feasible options in the management of Stage III N2 NSCLC. The different opinions reflected in the results of this manuscript reinforce the importance of a multidisciplinary setting and the importance of shared decision-making with the patient.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Thoracic Surgery
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology

UniBE Contributor:

Glatzer, Markus; Eliçin, Olgun; Kocher, Gregor; Zaugg, Kathrin and Putora, Paul Martin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2226-4477

Publisher:

AME Publishing

Language:

English

Submitter:

Beatrice Scheidegger

Date Deposited:

16 Jun 2021 15:00

Last Modified:

16 Jun 2021 15:08

Publisher DOI:

10.21037/tlcr-20-1210

PubMed ID:

34012806

Uncontrolled Keywords:

Non-small cell lung cancer (NSCLC) decision-making radiotherapy stage III N2 lung cancer surgery

BORIS DOI:

10.48350/156500

URI:

https://boris.unibe.ch/id/eprint/156500

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