Diagnosis and management of patients with stage III non‑small cell lung cancer: A joint statement by the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society (Review)

Abstract

Proper management of stage III non-small cell lung cancer (NSCLC) might result in a cure or patient long-term survival. Management should therefore be preceded by adequate and accurate diagnosis and staging, which will inform therapeutic decisions. A panel of oncologists, surgeons and pulmonologists in Lebanon convened to establish a set of recommendations to guide and unify clinical practice, in alignment with international standards of care. Whilst chest computerized tomography (CT) scanning remains a cornerstone in the discovery of a lung lesion, a positron-emission tomography (PET)/CT scan and a tumor biopsy allows for staging of the cancer and defining the resectability of the tumor(s). A multidisciplinary discussion meeting is currently widely advised for evaluating patients on a case-by-case basis, and should include at least the treating oncologist, a thoracic surgeon, a radiation oncologist and a pulmonologist, in addition to physicians from other specialties as needed. The standard of care for unresectable stage III NSCLC is concurrent chemotherapy and radiation therapy, followed by consolidation therapy with durvalumab, which should be initiated within 42 days of the last radiation dose; for resectable tumors, neoadjuvant therapy followed by surgical resection is recommended. This joint statement is based on the expertise of the physician panel, available literature and evidence governing the treatment, management and follow-up of patients with stage III NSCLC. Contents 1. Context 2. Screening and diagnosis 3. Diagnosing and staging lung cancer 4. Cardiopulmonary assessment 5. Tools to evaluate clinical profiles and performance of patients 6. Treatment and management of stage III NSCLC 7. Post-treatment management 8. Conclusion

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“…The incidence rate of non-small cell lung cancer (NSCLC) was about 85% of lung cancers (2). NSCLC was a heterogeneous disease invading the lung and adjacent tissues, eventually progressing and spreading to distant sites (3). A computed tomographic (CT) scan and a positron emission tomographic scan using 18 F-fluorodeoxyglucose was used for the staging of NSCLC (3,4).…”

“…NSCLC was a heterogeneous disease invading the lung and adjacent tissues, eventually progressing and spreading to distant sites (3). A computed tomographic (CT) scan and a positron emission tomographic scan using 18 F-fluorodeoxyglucose was used for the staging of NSCLC (3,4). Whilst chances for a complete remission or a cure were highest in early-stage cancers, survival rates decreased when the cancer was locally advanced (3,5).…”

“…A computed tomographic (CT) scan and a positron emission tomographic scan using 18 F-fluorodeoxyglucose was used for the staging of NSCLC (3,4). Whilst chances for a complete remission or a cure were highest in early-stage cancers, survival rates decreased when the cancer was locally advanced (3,5). Proper treatment of locally advanced NSCLC can result in a cure or long-term survival (3).…”

“…Whilst chances for a complete remission or a cure were highest in early-stage cancers, survival rates decreased when the cancer was locally advanced (3,5). Proper treatment of locally advanced NSCLC can result in a cure or long-term survival (3). A locally advanced lung tumor was resectable if surgery was sufficient to achieve complete tumor removal and if the patient was able to tolerate the surgery (3).…”