Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Department of Thoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Clin Oncol (R Coll Radiol). 2020 Aug;32(8):527-536. doi: 10.1016/j.clon.2020.03.001. Epub 2020 Mar 23.
The optimal management of stage III non-small cell lung cancer (NSCLC) is widely debated and is a rapidly evolving area. However, less than one in five stage III patients in England receive optimal multimodality treatment. The aim of this study was to map commonalities and differences in clinician judgement as well as infrastructure and resources for managing stage III NSCLC.
We carried out a national survey of practice in stage III NSCLC management in the UK using a 30-min web-based survey. Invitations were sent via e-mail to the British Thoracic Oncology Group and the Society of Cardiothoracic Surgery membership and a healthcare professional market research panel.
In total, 160 respondents completed the survey. Although opinion was variable, there was a preference for surgery and adjuvant chemotherapy in stage III N2 (single station) NSCLC that could be treated with lobectomy, but this preference switched to chemoradiotherapy in single-station N2 requiring a pneumonectomy or multi-station N2. The PD-L1 status influenced the treatment decision in 'potentially resectable' N2 for a number of clinicians who opted for concurrent chemoradiotherapy with adjuvant durvalumab when PD-L1 ≥ 1%. A joint clinic with surgeons and oncologists was considered the most important factor for shared decision making with patients. There are barriers to recommending trimodality treatment, e.g. concerns over the negative impact on quality of life. A proportion of clinicians favoured palliative treatment in certain clinical scenarios, including supraclavicular fossa lymph node metastases, patients with borderline fitness or high PD-L1 expressors >50%.
This survey has highlighted the need for infrastructure development, such as reflex PD-L1 testing and joint surgical and oncology clinics. Further research into the impact of multimodality treatment on quality of life and education to improve confidence in multimodality treatment could all drive improvements in stage III NSCLC management.
非小细胞肺癌（NSCLC）Ⅲ期的最佳治疗方案仍存在广泛争议，且这是一个迅速发展的领域。然而，在英国，仅有不到五分之一的Ⅲ期患者接受了最佳的多模式治疗。本研究旨在绘制临床医生判断以及管理Ⅲ期 NSCLC 的基础设施和资源方面的异同点。
我们使用 30 分钟的网络调查，对英国Ⅲ期 NSCLC 管理的实践情况进行了全国性调查。邀请通过电子邮件发送给英国胸科肿瘤学组和心胸外科协会的会员以及医疗保健专业市场研究小组。
共有 160 名受访者完成了调查。尽管意见存在差异，但对于可通过肺叶切除术治疗的Ⅲ期 N2（单站）NSCLC ，手术和辅助化疗是首选，但对于需要全肺切除术或多站 N2 的单站 N2，首选变为放化疗。对于许多 PD-L1 状态≥1%的临床医生，他们选择同步放化疗联合辅助度伐利尤单抗，将 PD-L1 状态作为“潜在可切除”N2 的治疗决策因素。与外科医生和肿瘤医生联合的联合诊所被认为是与患者共同决策的最重要因素。推荐三联疗法存在障碍，例如对生活质量产生负面影响的担忧。在某些临床情况下，包括锁骨上窝淋巴结转移、体能状况临界或 PD-L1 高表达率＞50%的患者，一部分临床医生倾向于姑息治疗。
本调查强调了基础设施发展的必要性，例如反射 PD-L1 检测和联合外科及肿瘤学诊所。进一步研究多模式治疗对生活质量的影响，以及提高对多模式治疗的信心的教育，都可能推动Ⅲ期 NSCLC 管理的改善。
