[Perioperative Therapy for Locally Advanced Non-small Cell Lung Cancer: Delphi Expert Consensus of the German Society...

The recent introduction of chemoimmunotherapy has permanently changed the multimodal therapeutic options for operable non-small cell lung cancer (NSCLC). The aim of the working group of the German Society for Thoracic Surgery (DGT) was to develop consensus-based practical recommendations for the perioperative treatment of locally advanced NSCLC.A questionnaire was formulated by defined working groups, which was answered in two electronic rounds by Germany's leading thoracic surgeons. Controversial results with less than 75% agreement were subsequently discussed in an expert conference and a Delphi survey was conducted.Patients with confirmed N1 or N2 lymph node metastasis should be treated in a perioperative regimen. Technical and oncological operability are obligate criteria as well as negative molecular status (at least EGFR and ALK wild type). Mediastinal invasive restaging is not required in the absence of radiological progression after induction therapy. Even with a good radiological response, surgery cannot be avoided. Because of a lack of evidence, it cannot be concluded to what extent a reduction in the extent of resection below a lobectomy is oncologically justifiable. The participants agreed that adjuvant radiotherapy has no value in patients with complete mediastinal downstaging. Patients with persistent mediastinal lymph node metastases (ypN2) should be discussed for adjuvant radiotherapy on a risk-adapted individual basis.A broad consensus was reached at the expert conference on the topics discussed in the context of the new perioperative therapy concepts. These can therefore serve as practice-oriented support for the members of the DGT.