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Resectability and Neoadjuvant Chemoimmunotherapy in Stage II-III Non-Small Cell Lung Cancer: A European Case-Vignette
Savvas Lampridis1,2, Akshay J Patel3,4, Eleni Josephides5
1Department of Thoracic Surgery, 424 General Military Hospital, Thessaloniki, Greece.
Summary
Management of stage II-III non-small cell lung cancer (NSCLC) varies among clinicians. This survey highlights significant divergence in assessing resectability and sequencing treatment, particularly for N2 disease, indicating a need for clearer guidelines.
Area of Science:
- Oncology
- Thoracic Surgery
- Medical Ethics
Background:
- Immunotherapy has advanced curative-intent options for non-small cell lung cancer (NSCLC).
- Current management recommendations for stage II-III NSCLC show considerable variability.
- Assessing resectability and treatment sequencing are key challenges in NSCLC management.
Purpose of the Study:
- To investigate variations in resectability assessment among clinicians for stage II-III NSCLC.
- To examine differences in treatment sequencing, including neoadjuvant chemoimmunotherapy, for stage II-III NSCLC.
- To identify areas of consensus and divergence in clinical decision-making for resectable and unresectable NSCLC.
Main Methods:
- A web-based case-vignette survey was distributed to European thoracic oncology clinicians.
- Seven stage II-III NSCLC vignettes, based on the TNM 9th edition, were presented.
- Respondents indicated yes/no for treatment options; primary outcome was neoadjuvant chemoimmunotherapy endorsement in resectable cases.
Main Results:
- Resectability was generally accepted for N0/N1 and some N2 scenarios, but lower for multi-station and T3/T4 N2 disease.
- Neoadjuvant chemoimmunotherapy endorsement increased for N2 cases considered resectable.
- Unresectable cases commonly received concurrent chemoradiotherapy; N2 involvement significantly predicted neoadjuvant chemoimmunotherapy use in resectable cases.
Conclusions:
- Significant variation exists in managing borderline N2 NSCLC, particularly multi-station and higher-T N2 disease.
- Clinicians differed on resectability definitions and preferred treatment pathways (surgery vs. chemoradiotherapy).
- Clearer multidisciplinary frameworks are needed for stage II-III NSCLC management, despite limitations of the current study's respondent pool and vignette design.
