Management of locally advanced non-small cell lung cancer in the modern era: A national Italian survey on diagnosis, treatment and multidisciplinary approach

Autoři: Alessio Bruni aff001;  Niccolò Giaj-Levra aff002;  Patrizia Ciammella aff003;  Virginia Maragna aff004;  Katia Ferrari aff005;  Viola Bonti aff005;  Francesco Grossi aff006;  Stefania Greco aff007;  Carlo Greco aff008;  Paolo Borghetti aff009;  Davide Franceschini aff010;  Enrica Capelletto aff011;  Marco Perna aff004;  Giuseppe Banna aff012;  Stefano Vagge aff013;  Editta Baldini aff014;  Emilio Bria aff015;  Andrea Botti aff016;  Marcello Tiseo aff017;  Massimiliano Paci aff018;  Maria Taraborrelli aff019;  Venerino Poletti aff020;  Pierluigi Granone aff022;  Umberto Ricardi aff023;  Silvia Novello aff011;  Vieri Scotti aff004
Působiště autorů: Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy aff001;  Department of Advanced Radiation Oncology, IRCCS Sacro Cuore–Don Calabria Hospital, Negrar, Verona, Italy aff002;  Radiation Therapy Unit, Department of Oncology and Advanced Technology, AUSL-IRCCS, Reggio Emilia, Italy aff003;  Radiation Therapy Unit, Department of Oncology, Careggi University Hospital, Firenze, Italy aff004;  Section of Respiratory Medicine, Careggi University Hospital, Firenze, Italy aff005;  UOC Oncologia Medica Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy aff006;  UOSD of Oncologic Pneumology, San Camillo Forlanini Hospital, Rome, Italy aff007;  Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy aff008;  Radiation Oncology Department University and Spedali Civili, Brescia, Italy aff009;  Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy aff010;  Oncology Department, University of Turin, AOU San Luigi, Orbassano (TO), Italy aff011;  Oncology Department, Ospedale Cannizzaro, Catania, Italy aff012;  Department of Radiation Oncology, Azienda Ospedaliera Universitaria San Martino di Genova—IST, Istituto Nazionale Ricerca sul Cancro, Genoa, Italy aff013;  UOC Oncologia Medica Ospedale San Luca, Lucca, Italy aff014;  U.O.C. Oncologia Medica, Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli, IRCCS—Università Cattolica del Sacro Cuore, Roma, Italy aff015;  Medical Physics Unit, Department of Oncology and Advanced Technology, AUSL-IRCCS, Reggio Emilia, Italy aff016;  Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy aff017;  Division of Thoracic Surgery, Azienda USL-IRCCS of Reggio Emilia, Italy aff018;  Radiotherapy Unit, SS Annunziata Hospital—G. D'annunzio University, Chieti, Italy aff019;  Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì (I), Italy aff020;  Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark aff021;  Department of General Thoracic Surgery, Catholic University, Rome, Italy aff022;  Department of Oncology, University of Turin, Torino, Italy aff023
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224027


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.

Klíčová slova:

Cancer detection and diagnosis – Cancer treatment – Diagnostic medicine – Lung and intrathoracic tumors – Non-small cell lung cancer – Oncology – Physicians – Surgical and invasive medical procedures


1. Aupérin A, Le Péchoux C, Rolland E, Curran WJ, Furuse K, Fournel P et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol. 2010;28(13):2181–90. doi: 10.1200/JCO.2009.26.2543 20351327

2. Glatzer M, Elicin O, Ramella S, Nestle U, Putora PM. Radio(chemo)therapy in locally advanced nonsmall cell lung cancer. Eur Respir Rev 2016; 25: 65–70. doi: 10.1183/16000617.0053-2015 26929423

3. Dillman RO, Seagren SL, Propert KJ, Guerra J, Eaton WL, Perry MC et al. A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. N Engl J Med 1990; 323: 940–945. doi: 10.1056/NEJM199010043231403 2169587

4. O’Rourke N, Roqué I Figuls M, Farré Bernadó N, Macbeth F. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev 2010; 6: CD002140.

5. Bradley JD, Paulus R, Komaki R, Masters G, Blumenschein G, Schild S et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol 2015; 16: 187–199. doi: 10.1016/S1470-2045(14)71207-0 25601342

6. Non-small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer. A meta-analysis using updated data on individual patients from 52 randomised clinical trials. BMJ. 1995;311:899–909. [no author listed] 7580546

7. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R et al. Durvalumab after Chemoradiotherapy in Stage III Non–Small-Cell Lung Cancer. N Engl J Med. 2017;377(20):1919–1929. doi: 10.1056/NEJMoa1709937 28885881

8. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R et al. Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC. N Engl J Med. 2018;379(24):2342–2350. doi: 10.1056/NEJMoa1809697 30280658

9. De Leyn P, Dooms C, Kuzdzal J, Lardinois D, Passlick B, Rami-Porta R et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2014;45(5):787–98. doi: 10.1093/ejcts/ezu028 24578407

10. Adams K, Shah PL, Edmonds L, Lim E. Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax 2009;64:757–62. doi: 10.1136/thx.2008.109868 19454408

11. Chandra S, Nehra M, Agarwal D, Mohan A. Diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle biopsy in mediastinal lymphadenopathy: a systematic review and meta-analysis. Respir Care 2012;57:384–91. doi: 10.4187/respcare.01274 22004665

12. Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(suppl_4):iv1–iv21. doi: 10.1093/annonc/mdx222 28881918

13. Bilfinger TV, Albano D, Perwaiz M, Keresztes R, Nemesure B et al. Survival Outcomes Among Lung Cancer Patients Treated Using a Multidisciplinary Team Approach. Clin Lung Cancer. 2018;19:346–351. doi: 10.1016/j.cllc.2018.01.006 29506890

14. Crawford SM. Multidisciplinary team working contributes to lung cancer survival. BMJ. 2018;361:k1904. doi: 10.1136/bmj.k1904 29925606

15. Campbell BA, Ball D, Mornex F. Multidisciplinary lung cancer meetings: improving the practice of radiation oncology and facing future challenges. Respirology. 2015;20:192–8. doi: 10.1111/resp.12459 25581058

16. Albain KS, Swann RS, Rusch VW, Turrisi AT 3rd, Shepherd FA, Smith C, 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: 379–386. doi: 10.1016/S0140-6736(09)60737-6 19632716

17. Pless M, Stupp R, Ris HR, Stahel RA, Weder W, Thierstein S et al. Induction chemoradiation in stage IIIA/ N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet 2015; 386: 1049–1056. doi: 10.1016/S0140-6736(15)60294-X 26275735

18. Eberhardt WE, Pottgen C, Gauler TC, Friedel G, Veit S, Heinrich V et al. Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA(N2) and selected IIIB non–small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE). J Clin Oncol 2015; 33: 4194–4201. doi: 10.1200/JCO.2015.62.6812 26527789

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2019 Číslo 11