Agbarya Abed, Shalata Walid, Addeo Alfredo, Charpidou Andriani, Cuppens Kristof, Brustugun Odd Terje, Rajer Mirjana, Jakopovic Marco, Marinca Mihai V, Pluzanski Adam, Hiltermann Jeroen, Araújo António
Oncology Department, Bnai Zion Medical Center, Haifa 3339419, Israel.
The Legacy Heritage Oncology and Larry Norton Institute, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel.
J Clin Med. 2022 Mar 21;11(6):1738. doi: 10.3390/jcm11061738.
Daily-practice challenges in oncology have been intensified by the approval of immune checkpoint inhibitors (ICI). We aimed to outline current therapy policies and management of locally advanced unresectable stage III non-small-cell lung cancer (NSCLC) in different countries. One thoracic oncologist from each of the following countries-Belgium, Croatia, Greece, Israel, the Netherlands, Norway, Poland, Portugal, Romania, Slovenia, and Switzerland-participated in an electronic survey. Descriptive statistics were conducted with categorical variables reported as frequencies and continuous variables as median and interquartile range (IQR) (StataSE-v15). EBUS (endobronchial ultrasound bronchoscopy) was used either upfront or for N2 confirmation. Resectability is still a source of disagreement; thus, decisions vary within each multidisciplinary team. Overall, 66% of stage III patients [IQR 60-75] undergo chemoradiation therapy (CRT); concurrent CRT (cCRT) accounts for most cases (~70%). Performance status is universally used for cCRT eligibility. Induction chemotherapy is fairly weighted based on radiotherapy (RT) availability. Mean time to evaluation after RT completion is less than a month; ICI consolidation is started within six weeks. Durvamulab expenditures are reimbursed in all countries, yet some limiting criteria exist (PD-L1 ≥ 1%, cCRT). No clear guidance on therapies at Durvamulab progression exist; experts agree that it depends on progression timing. Given the high heterogeneity in real-world practices, standardized evidence-based decisions and healthcare provision in NSCLC are needed.
免疫检查点抑制剂（ICI）的获批加剧了肿瘤学日常实践中的挑战。我们旨在概述不同国家局部晚期不可切除的III期非小细胞肺癌（NSCLC）的当前治疗策略和管理方法。来自比利时、克罗地亚、希腊、以色列、荷兰、挪威、波兰、葡萄牙、罗马尼亚、斯洛文尼亚和瑞士的每位胸科肿瘤学家参与了一项电子调查。使用描述性统计分析，分类变量以频率报告，连续变量以中位数和四分位数间距（IQR）报告（StataSE-v15）。超声支气管镜检查（EBUS）可在初始时使用或用于N2确认。可切除性仍是一个存在分歧的问题；因此，每个多学科团队内部的决策各不相同。总体而言，66%的III期患者[IQR 60 - 75]接受放化疗（CRT）；同步放化疗（cCRT）占大多数病例（约70%）。体能状态普遍用于评估cCRT的适用性。诱导化疗根据放疗（RT）的可及性进行合理权衡。放疗完成后平均评估时间少于一个月；ICI巩固治疗在六周内开始。所有国家均报销度伐单抗费用，但存在一些限制标准（PD-L1≥1%，cCRT）。对于度伐单抗进展后的治疗尚无明确指导；专家们一致认为这取决于进展时间。鉴于现实世界实践中的高度异质性，NSCLC需要标准化的基于证据的决策和医疗服务。
