Interpretation of the Society of Thoracic Surgeons expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HAN Yichao , FAN Jingyuan , DU Mingyuan , LI Tiancheng ,  LI Hecheng

Department of Thoracic Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China;

Corresponding author：

LI Hecheng, Email: lihecheng2000@hotmail.com

Keywords：

Lung cancer; surgery; resectability; perioperative therapy; adjuvant therapy; interpretation

DOI：

10.7507/1007-4848.202501006

Video：

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With the continuous advancements in immunotherapy and targeted therapy, there have been significant changes in the treatment management and surgical resection assessment of locally advanced lung cancer. In October 2024, the Society of Thoracic Surgeons (STS) published the “STS expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer”. This expert consensus aims to provide the latest insights on the assessment of resectability and multidisciplinary management of locally advanced lung cancer, focusing on three key areas: neoadjuvant (including perioperative) therapy, adjuvant therapy, and the overall management approach. This article aims to interpret the consensus, with the intention of introducing the latest perspectives of the STS consensus to thoracic surgeons. It seeks to provide a reference for the rational implementation of surgical resection and multidisciplinary management of non-small cell lung cancer in China, as well as for the standardization of comprehensive treatment models.

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7. Sorin M, Prosty C, Ghaleb L, et al. Neoadjuvant chemoimmunotherapy for NSCLC: A systematic review and meta-analysis. JAMA Oncol, 2024, 10(5): 621-633.
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11. O'Brien M, Paz-Ares L, Marreaud S, et al. Pembrolizumab versus placebo as adjuvant therapy for completely resected stage ⅠB-ⅢA non-small-cell lung cancer (PEARLS/KEYNOTE-091): An interim analysis of a randomised, triple-blind, phase 3 trial. Lancet Oncol, 2022, 23(10): 1274-1286.
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14. Wakelee H, Liberman M, Kato T, et al. Perioperative pembrolizumab for early-stage non-small-cell lung cancer. N Engl J Med, 2023, 389(6): 491-503.
15. Bracci L, Schiavoni G, Sistigu A, et al. Immune-based mechanisms of cytotoxic chemotherapy: implications for the design of novel and rationale-based combined treatments against cancer. Cell Death Differ, 2014, 21(1): 15-25.
16. Glover J, Velez-Cubian FO, Toosi K, et al. Perioperative outcomes and lymph node assessment after induction therapy in patients with clinical N1 or N2 non-small cell lung cancer. J Thorac Dis, 2016, 8(8): 2165-2174.
17. Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage Ⅲ non-small-cell lung cancer: A phase Ⅲ randomised controlled trial. Lancet, 2009, 374(9687): 379-386.
18. Pless M, Stupp R, Ris HB, et al. Induction chemoradiation in stage ⅢA/N2 non-small-cell lung cancer: A phase 3 randomised trial. Lancet, 2015, 386(9998): 1049-1056.
19. van Meerbeeck JP, Kramer GW, Van Schil PE, et al. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage ⅢA-N2 non-small-cell lung cancer. J Natl Cancer Inst, 2007, 99(6): 442-450.
20. Detterbeck FC, Woodard GA, Bader AS, et al. The proposed ninth edition TNM classification of lung cancer. Chest, 2024, 166(4): 882-895.
21. Zhou Q, Pan Y, Yang X, et al. Neoadjuvant SHR-1701 with or without chemotherapy in unresectable stage Ⅲ non-small-cell lung cancer: A proof-of-concept, phase 2 trial. Cancer Cell, 2024, 42(7): 1258-1267.
22. Xia H, Zhang H, Ruan Z, et al. Neoadjuvant camrelizumab (an anti-PD-1 antibody) plus chemotherapy or apatinib (a VEGFR-2 inhibitor) for initially unresectable stage Ⅱ-Ⅲ non-small-cell lung cancer: A multicentre, two-arm, phase 2 exploratory study. Signal Transduct Target Ther, 2024, 9(1): 145.
23. De Leyn P, Dooms C, Kuzdzal J, et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2014, 45(5): 787-798.
24. Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e211S-e250S.
25. Darling GE, Li F, Patsios D, et al. Neoadjuvant chemoradiation and surgery improves survival outcomes compared with definitive chemoradiation in the treatment of stage ⅢA N2 non-small-cell lung cancer. Eur J Cardiothorac Surg, 2015, 48(5): 684-690.
26. McElnay PJ, Choong A, Jordan E, et al. Outcome of surgery versus radiotherapy after induction treatment in patients with N2 disease: Systematic review and meta-analysis of randomised trials. Thorax, 2015, 70(8): 764-768.
27. Stefani A, Alifano M, Bobbio A, et al. Which patients should be operated on after induction chemotherapy for N2 non-small cell lung cancer? Analysis of a 7-year experience in 175 patients. J Thorac Cardiovasc Surg, 2010, 140(2): 356-363.
28. Martins RG, D'Amico TA, Loo BW, et al. The management of patients with stage ⅢA non-small cell lung cancer with N2 mediastinal node involvement. J Natl Compr Canc Netw, 2012, 10(5): 599-613.
29. Betticher DC, Hsu Schmitz SF, Tötsch M, et al. Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage ⅢA pN2 non-small-cell lung cancer: A multicenter phase Ⅱ trial. J Clin Oncol, 2003, 21(9): 1752-1759.
30. Yang HX, Hou X, Lin P, et al. Survival and risk factors of surgically treated mediastinal invasion T4 non-small cell lung cancer. Ann Thorac Surg, 2009, 88(2): 372-378.
31. Lucchi M, Viti A, Melfi F, et al. ⅢB-T4 non-small cell lung cancer: Indications and results of surgical treatment. J Cardiovasc Surg (Torino). 2007, 48(3): 369-374.
32. Kumar A, Gandhi K, Gilja S, et al. Multimodal therapy for T4 N2 non-small cell lung cancer with additional ipsilateral pulmonary nodules. Ann Thorac Surg Short Rep, 2023, 1(4): 566-569.
33. Yamanashi K, Menju T, Hamaji M, et al. Prognostic factors related to postoperative survival in the newly classified clinical T4 lung cancer. Eur J Cardiothorac Surg, 2020, 57(4): 754-761.
34. Wang F, Su H, E H, et al. Reconsidering T component of cancer staging for T3/T4 non-small-cell lung cancer with additional nodule. Ther Adv Med Oncol, 2022, 14: 17588359221130502.
35. Le Pechoux C, Pourel N, Barlesi F, et al. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): An open-label, randomised, phase 3 trial. Lancet Oncol, 2022, 23(1): 104-114.
36. Li Q, Zhang P, Wang Y, et al. T4 extension alone is more predictive of better survival than a tumour size >7 cm for resected T4N0-1M0 non-small-cell lung cancer. Eur J Cardiothorac Surg, 2019, 55(4): 682-690.
37. de Perrot M, Fadel E, Mercier O, et al. Long-term results after carinal resection for carcinoma: does the benefit warrant the risk? J Thorac Cardiovasc Surg, 2006, 131(1): 81-89.
38. DiPerna CA, Wood DE. Surgical management of T3 and T4 lung cancer. Clin Cancer Res, 2005, 11(13 Pt 2): 5038s-5044s.
39. Shen KR, Meyers BF, Larner JM, et al. Special treatment issues in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 290S-305S.
40. Kawaguchi K, Yokoi K, Niwa H, et al. A prospective, multi-institutional phase Ⅱ study of induction chemoradiotherapy followed by surgery in patients with non-small cell lung cancer involving the chest wall (CJLSG0801). Lung Cancer, 2017, 104: 79-84.
41. Anraku M, Waddell TK, de Perrot M, et al. Induction chemoradiotherapy facilitates radical resection of T4 non-small cell lung cancer invading the spine. J Thorac Cardiovasc Surg, 2009, 137(2): 441-447.
42. Rusch VW, Giroux DJ, Kraut MJ, et al. Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas: Long-term results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160). J Clin Oncol, 2007, 25(3): 313-318.
43. Detterbeck FC. Changes in the treatment of Pancoast tumors. Ann Thorac Surg, 2003, 75(6): 1990-1997.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesInterpretation of the Society of Thoracic Surgeons expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer

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