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Definition of resectable stage III non-small cell lung cancer (NSCLC) for inclusion in clinical trials: A clinical case review by a pan-European multidisciplinary expert panel led by the EORTC Lung Cancer Group

par Brandão, Mariana ;Prisciandaro, Elena;Xenophontos, Eleni;Mariolo, Alessio;Sadeghi, Amir H.;Filippi, Andrea R.;Levy, Antonin;Bandura, Artur;Caramella, Caroline;Dickhoff, Chris;de Margerie-Mellon, Constance;Faivre-Finn, Corinne;Portik, Daniel;Sanchez-Lorente, David;Ruysscher, Dirk De;Smit, Egbert;Gobbini, Elisa;Fadel, Elie;Ruffini, Enrico;Olmetto, Emanuela;Cortiula, Francesco;Bahce, Idris;Houda, Ilias;Opitz, Isabelle;Naidoo, Jarushka;Edwards, John;Remon, Jordi;Benitez, José Carlos;Trujillo, Juan Carlos;Derks, Jules;Amrane, Karim;Hartemink, Koen;Stathopoulos, Konstantinos;Hendriks, Lizza E.L.;Iglesias, Manoli;Occhipinti, Mario;Guckenberger, Matthias;Levra, Niccolo Giaj;Girard, Nicolas;Reguart, Noemi;Mercier, Olaf;Bironzo, Paolo;Hofman, Paul;Petersen, Rene Horsleben;Angelis, Riccardo De;Abgral, Ronan;Terrisse, Safae;Popat, Sanjay;Pierret, Thomas;Blum, Torsten Gerriet;Ricardi, Umberto;Dionisi, Valeria;Berghmans, Thierry ;Dingemans, Anne-Marie C.
Référence Lung cancer, page (108798)
Publication Publié, 2025-10-01

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Résumé :

Introduction: Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease, leading to ambiguity in resectability criteria. This has prompted the EORTC Lung Cancer Group to establish a standardized definition of resectability for clinical trials. A Delphi consensus process was initiated, including a systematic review, survey, and clinical cases review. Here, we report exclusively the results of the clinical cases review, aimed to categorize cases based on tumor and lymph node factors, to identify those deemed surgically resectable upfront. Methods: Consecutive patients with clinical stage III NSCLC (8th TNM edition) treated at Institut Jules Bordet between 2016–2021 were identified. These cases underwent evaluation by multidisciplinary panels (MDT), comprising thoracic surgeons, radiation oncologists, medical oncologists/pulmonologists and imaging specialists. The MDT determined the resectability of each tumor, and non-consensual cases underwent a second and a third discussion rounds. A TNM-subset was classified as “resectable” if ≥75 % of cases within that category were deemed “resectable” following multiple rounds of review. Results: Among 105 cases, 52 % of tumors were stage IIIA, 36 % stage IIIB and 11 % stage IIIC. After the first two review rounds, 13 % of cases were classified as “no consensus” and moved to a third round. The main reasons were suboptimal imaging (n = 8), incomplete invasive mediastinal staging to assess the N factor (n = 3), and disagreement on the resectability of T4 tumors invading thoracic structures or with multi-station/bulky N2 disease (n = 3). After the third review round, T3-T4 tumors based on size/satellite nodules and/or with N1-N2 single-station involvement were considered resectable. In contrast, many invasive T4-tumors were considered unresectable, especially if combined with N2-N3 disease. N2-multi-station, N2-bulky or N3 involvement were generally considered unresectable (100 %/95 %/95 % respectively). Conclusions: After a multiple-round multidisciplinary review of real-world cases, consensus was reached for most TNM-subsets, except for invasive T4N0 tumors. This case review informed the Consensual Definition of Resectable stage III NSCLC in clinical trials.