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

Autor:	Glatzer M; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland., Leskow P; Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland., Caparrotti F; Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland., Elicin O; Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland., Furrer M; Department of Vascular and Thoracic Surgery, Kantonsspital Chur, Chur, Switzerland., Gambazzi F; Department of Thoracic Surgery, Kantonsspital Aarau, Aarau, Switzerland., Dutly A; Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland., Gelpke H; Department of Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland., Guckenberger M; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Heuberger J; Department of Radiation Oncology, Kantonsspital Aarau, Aarau, Switzerland., Inderbitzi R; Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland., Cafarotti S; Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland., Karenovics W; Department of Thoracic Surgery, University Hospital Geneva, Geneva, Switzerland., Kestenholz P; Department of Thoracic Surgery, Kantonsspital Luzern, Luzern, Switzerland., Kocher GJ; Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland., Kraxner P; Department of Radiation Oncology, Kantonsspital Luzern, Luzern, Switzerland.; Department of Radiation Oncology, Kantonsspital Chur, Chur, Switzerland., Krueger T; Department of Thoracic Surgery, University Hospital Lausanne, Lausanne, Switzerland., Martucci F; Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Switzerland., Oehler C; Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland., Ozsahin M; Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., Papachristofilou A; Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland., Wagnetz D; Department of Visceral-Vascular and Thoracic Surgery, City Hospital Waid and Triemli, Zurich, Switzerland., Zaugg K; Department of Radiation Oncology, City Hospital Waid and Triemli, Zurich, Switzerland., Zwahlen D; Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland., Opitz I; Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland., Putora PM; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.; Department of Radiation Oncology, University of Bern, Bern, Switzerland.
Jazyk:	angličtina
Zdroj:	Translational lung cancer research [Transl Lung Cancer Res] 2021 Apr; Vol. 10 (4), pp. 1960-1968.
DOI:	10.21037/tlcr-20-1210
Abstrakt:	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. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-1210). The series “Radiotherapy in thoracic malignancies” was commissioned by the editorial office without any funding or sponsorship. PMP received an educational grant from AstraZeneca (educational grant to the Institution); outside the submitted work, he also received research support and educational grants to the department from Celgene, Roche and Takeda. The authors have no other conflicts of interest to declare. (2021 Translational Lung Cancer Research. All rights reserved.)
Databáze:	MEDLINE
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