Lung cancer remains a significant global health challenge, with a low five-year survival rate of only 18%. Surgery has traditionally been the mainstay treatment for early stage or select locally advanced non-small cell lung cancer (NSCLC). However, with advancements in systemic therapies and surgical techniques, the role of surgical intervention is rapidly evolving.
Forming a New Consensus Definition
A paper recently published in The Annals of Thoracic Surgery, written by a multidisciplinary group of experts, has redefined the concept of resectability for locally advanced NSCLC. The paper establishes a new consensus definition that considers not only the anatomical feasibility of surgical removal, but also biological factors relevant to the prognosis and effectiveness of non-surgical therapies.
"This document provides a tool to clinicians so they may provide more comprehensive and personalized treatments for patients with locally advanced NSCLC and ensure that surgery is only pursued when it truly offers the best chance for improved outcomes,” said Samuel Kim, MD, of Northwestern Medicine, who chaired the task force that produced the document.
Methodology
The agreed-upon statements were developed through a thorough review of the literature and a modified Delphi method. The task force, which included thoracic surgeons, medical oncologists, and radiation oncologists, examined more than 150 research papers to guide their conclusions. “The Delphi method, utilizing multiple rounds of anonymous voting, is the best way to establish an unbiased consensus, making it the optimal choice for situations where there is a lack of definitive evidence on the topic,” said Dr. Kim.
Key Focus Areas
These experts reached a strong consensus on the key statements related to three areas — resectability, neoadjuvant therapy, and adjuvant therapy — and focused on 14 specific statements, including:
- the role of the multidisciplinary tumor board
- management of NSCLC patients with single or multiple N2 node involvement
- multi-disciplinary management of T4 disease
- neoadjuvant vs. perioperative therapy in resectable NSCLC
- the role of induction targeted therapy
- the role of adjuvant systemic therapy and radiation treatment
“We’re moving closer to a future where patients with locally advanced lung cancer are receiving more personalized and effective treatments,” said Dr. Kim. “By considering factors beyond the tumor’s size and location, we can better identify those who are likely to benefit from surgery and minimize unnecessary procedures. We hope this document informs clinicians of the latest data and helps guide the care of patients with locally advanced non-small cell lung cancer.”