An international and multidisciplinary EORTC survey on resectability of stage III non-small cell lung cancer

Ilias Houda; Idris Bahce; Chris Dickhoff; Tiuri E Kroese; Stephanie G C Kroeze; Alessio V Mariolo; Marco Tagliamento; Laura Moliner; Mariana Brandão; Yassin Pretzenbacher; John Edwards; Isabelle Opitz; Alessandro Brunelli; Matthias Guckenberger; Paul E van Schil; Sanjay Popat; Torsten Blum; Corinne Faivre-Finn; Dirk de Ruysscher; Jordi Remon; Thierry Berghmans; Anne-Marie C Dingemans; Benjamin Besse; Lizza E L Hendriks

doi:10.1016/j.lungcan.2024.108061

An international and multidisciplinary EORTC survey on resectability of stage III non-small cell lung cancer

Lung Cancer. 2024 Dec 15:199:108061. doi: 10.1016/j.lungcan.2024.108061. Online ahead of print.

Authors

Ilias Houda¹, Idris Bahce², Chris Dickhoff³, Tiuri E Kroese⁴, Stephanie G C Kroeze⁵, Alessio V Mariolo⁶, Marco Tagliamento⁷, Laura Moliner⁸, Mariana Brandão⁹, Yassin Pretzenbacher¹⁰, John Edwards¹¹, Isabelle Opitz¹², Alessandro Brunelli¹³, Matthias Guckenberger¹⁴, Paul E van Schil¹⁵, Sanjay Popat¹⁶, Torsten Blum¹⁷, Corinne Faivre-Finn¹⁸, Dirk de Ruysscher¹⁹, Jordi Remon²⁰, Thierry Berghmans²¹, Anne-Marie C Dingemans²², Benjamin Besse²³, Lizza E L Hendriks²⁴

Affiliations

¹ Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands. Electronic address: [email protected].
² Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands. Electronic address: [email protected].
³ Department of Cardiothoracic Surgery, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands. Electronic address: [email protected].
⁴ Department of Radiation Oncology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. Electronic address: [email protected].
⁵ Department of Radiation Oncology, Kantonsspital Aarau AG, Tellstrasse 25, 5001 Aarau, Switzerland. Electronic address: [email protected].
⁶ Department of Thoracic Surgery, Curie-Montsouris Thoracic Institute, 42 Bd Jourdan, 75014 Paris, France. Electronic address: [email protected].
⁷ Department of Medical Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Viale Benedetto XV, 6, 16132 Genova, GE, Italy. Electronic address: [email protected].
⁸ Department of Oncology, Institut Catala d'Oncologia, Avinguda de la Granvia de l'Hospitalet, 199, 08908 L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: [email protected].
⁹ Department of Medical Oncology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Mijlenmeersstraat 90, 1070 Brussels, Belgium. Electronic address: [email protected].
¹⁰ European Organisation For Research And Treatment Of Cancer (EORTC), Avenue Emmanuel Mounier 83/11, 1200 Brussels, Belgium. Electronic address: [email protected].
¹¹ Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, United Kingdom. Electronic address: [email protected].
¹² Department of Thoracic Surgery, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. Electronic address: [email protected].
¹³ Department of Thoracic Surgery, St. James's University Hospital, Beckett Street, LS9 7TF Leeds, United Kingdom. Electronic address: [email protected].
¹⁴ Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. Electronic address: [email protected].
¹⁵ Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
¹⁶ Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, United Kingdom. Electronic address: [email protected].
¹⁷ Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Walterhöferstraße 11, 14165 Berlin, Germany; Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany. Electronic address: [email protected].
¹⁸ Department of Radiation Oncology, The Christie NHS Foundation Trust, Wilmslow Rd, Manchester M20 4BX, United Kingdom; University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom. Electronic address: [email protected].
¹⁹ Department of Radiation Oncology, GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Radiotherapy, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. Electronic address: [email protected].
²⁰ Department of Medical Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France. Electronic address: [email protected].
²¹ Department of Medical Oncology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Mijlenmeersstraat 90, 1070 Brussels, Belgium. Electronic address: [email protected].
²² Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. Electronic address: [email protected].
²³ Department of Medical Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France. Electronic address: [email protected].
²⁴ Department of Pulmonary Medicine, GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands. Electronic address: [email protected].

PMID: 39705827
DOI: 10.1016/j.lungcan.2024.108061

Abstract

Introduction: The EORTC-Lung Cancer Group initiated a Delphi consensus process to establish a consensual definition of resectable stage III non-small cell lung cancer (NSCLC) for the use in clinical trials, including a systematic review, survey, and review of clinical cases. Here, the survey results are presented, aimed to identify areas of controversy.

Methods: A survey was distributed among the members of six international organizations related to lung cancer. Respondents were interrogated on the resectability (not limited to the technical resectability) of all stage III NSCLC TNM-subsets (8th edition). Additionally, four N2-subdivisions were used. The threshold for agreement was 75%. Answers with "yes" were considered upfront resectable. "Yes" and "maybe" were grouped together and considered potentially resectable. Answers with "no" were considered unresectable.

Results: 558 responses were collected from thoracic surgeons (38%), radiation oncologists (27%), medical oncologists (17%), pulmonologists (14%), and others (4%). Most worked in a specialized center (80%), had >5 years of experience (80%), were European (76%), male (73%), and treated >20 patients with stage III NSCLC annually (77%). Agreement was found in 26 (70%) out of 37 TNM-subsets: 9 (24%) were considered (potentially) resectable, and 17 (46%) unresectable. There was no agreement for 11 (30%) TNM-subsets: smaller tumors with N2-multistation, larger tumors with N2-single station, and invasive T4-tumors with maximum N2-single station involvement.

Conclusions: This international and multidisciplinary survey showed agreement on the resectability for the majority of stage III NSCLC TNM-subsets, but also identified several TNM-subsets for which no agreement was found.

Keywords: Immune checkpoint inhibitors; Lung neoplasms; Non-small cell lung cancer; Resectability; Surgery.