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Abstract
Concurrent chemotherapy and radiotherapy (cCRT) is considered the standard treatment of locally advanced non-small cell lung cancer (LA-NSCLC). Unfortunately, management is still heterogeneous across different specialists. A multidisciplinary approach is needed in this setting due to recent, promising results obtained by consolidative immunotherapy. The aim of this survey is to assess current LA-NSCLC management in Italy. From January to April 2018, a 15-question survey focusing on diagnostic/therapeutic LA-NSCLC management was sent to 1,478 e-mail addresses that belonged to pneumologists, thoracic surgeons, and radiation and medical oncologists. 421 answers were analyzed: 176 radiation oncologists, 86 medical oncologists, 92 pneumologists, 64 thoracic surgeons and 3 other specialists. More than a half of the respondents had been practicing for >10 years after completing residency training. Some discrepancies were observed in clinical LA-NSCLC management: the lack of a regularly planned multidisciplinary tumor board, the use of upfront surgery in multistation stage IIIA, and territorial diffusion of cCRT in unresectable LA-NSCLC. Our analysis demonstrated good compliance with international guidelines in the diagnostic workup of LA-NSCLC. We observed a relationship between high clinical experience and good clinical practice. A multidisciplinary approach is mandatory for managing LA-NSCLC.
Highlights
IntroductionConcomitant radiotherapy and chemotherapy (cCRT) represents the standard of care in “fit patients” (defined as patients with good performance status, no or mild comorbidities, and potentially able to undergo a multimodal approach as reported in the RTOG0617 trial) with a diagnosis of locally advanced non-small cell lung cancer (LA-NSCLC) [1,2]
Concomitant radiotherapy and chemotherapy represents the standard of care in “fit patients” with a diagnosis of locally advanced non-small cell lung cancer (LA-NSCLC) [1,2]
Our analysis demonstrated good compliance with international guidelines in the diagnostic workup of LA-NSCLC
Summary
Concomitant radiotherapy and chemotherapy (cCRT) represents the standard of care in “fit patients” (defined as patients with good performance status, no or mild comorbidities, and potentially able to undergo a multimodal approach as reported in the RTOG0617 trial) with a diagnosis of locally advanced non-small cell lung cancer (LA-NSCLC) [1,2]. This combination is widely adopted due to strong, evidence-based results on overall survival (OS), progression free survival (PFS), and local control (LC) [3,4] when compared to a sequential approach. Good results were obtained using immunotherapy (IT) after cCRT with a significant improvement in PFS and OS, with no impact in severe acute/late toxicity profiles [5,7,8]
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