Asian Thoracic Oncology Research Group Expert Consensus Statement on Optimal Management of Stage III NSCLC

Abstract

Stage III NSCLC represents a heterogeneous disease for which optimal treatment continues to pose a clinical challenge. Recent changes in the American Joint Commission on Cancer staging to the eighth edition has led to a shift in TNM stage grouping and redefined the subcategories (IIIA-C) in stage III NSCLC for better prognostication. Although concurrent chemoradiotherapy has remained standard-of-care for stage III NSCLC for almost 2 decades, contemporary considerations include the impact of different molecular subsets of NSCLC, and the roles of tyrosine kinase inhibitors post-definitive therapy and of immune checkpoint inhibitors following chemoradiotherapy. With rapid evolution of diagnostic algorithms and expanding treatment options, the need for interdisciplinary input involving multiple specialists (medical oncologists, radiation oncologists, pulmonologists, radiologists, pathologists and thoracic surgeons) has become increasingly important. The unique demographics of Asian NSCLC pose further challenges when applying clinical trial data into clinical practice. This includes differences in smoking rates, prevalence of oncogenic driver mutations, and access to health care resources including molecular testing, prompting the need for critical review of existing data and identification of current gaps. In this expert consensus statement by the Asian Thoracic Oncology Research Group, an interdisciplinary group of experts representing

Prognostic Factor and Clinical Outcome in Stage III Non-Small Cell Lung Cancer: A Study Based on Real-World Clinical Data in the Korean Population

“…Moreover, upfront surgery for stage III NSCLC has been more commonly performed in Asian population than in populations of western countries [9]. Indeed, a recent expert consensus statement in Asia suggested a proposed clinical algorithm for stage III NSCLC, which divided patients as resectable, potentially resectable, and unresectable cases [10].…”

Patient prognostic scores and association with survival improvement offered by postoperative radiotherapy for resected IIIA/N2 non‐small cell lung cancer: A population‐based study

“…In the Asian Thoracic Oncology Research Group expert consensus statement on optimal management of stage III NSCLC by Tan et al, the consensus statement emphasized that PORT should be considered for stage N2 NSCLC patients in whom the benefit outweighs risk of excess toxicity 5 . As IIIA/N2 NSCLC were diseases heterogeneous in levels of age, grade, T stage and LNR, identifying patients who might derive the greatest (or least) benefit from PORT, based on the disease characteristics, was necessary.…”

“…Locally advanced NSCLC, specifically N2 disease, has a higher risk of local relapse and distant metastasis after treatment and a poorer prognosis 3,4 . Surgery‐based multimodal therapies are considered as the optimal therapeutic strategy for patients with locally advanced disease 4,5 . However, there is currently no consensus on the role of postoperative adjuvant radiotherapy (PORT) for locally advanced NSCLC, as the benefit on survival remains uncertain 6–10 .…”

Novel nomograms to predict lymph node metastasis and distant metastasis in resected patients with early-stage non-small cell lung cancer

“…The 5-year survival rates of lung cancer fluctuate ranging from 4% to 17%, which is primarily ascribed to tumor stage and regional discrepancy (6,7). The unsatisfactory prognosis and frequent recurrence of NSCLC are closely associated with lymph node metastasis (LNM) and distant metastasis (8).…”