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Araújo A, Barroso A, Parente B, Travancinha C, Teixeira E, Martelo F, Fernandes G, Paupério G, Queiroga H, Duarte I, da Costa JD, Soares M, Borralho P, Costa P, Chinita P, Almodôvar T, Barata F. Unresectable stage III non-small cell lung cancer: Insights from a Portuguese expert panel. Pulmonology 2024; 30:159-169. [PMID: 36717296 DOI: 10.1016/j.pulmoe.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 10/29/2022] [Accepted: 11/29/2022] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION The management of unresectable stage III non-small cell lung cancer (NSCLC) is clinically challenging and there is no current consensus on optimal strategies. Herein, a panel of Portuguese experts aims to present practical recommendations for the global management of unresectable stage III NSCLC patients. METHODS A group of Portuguese lung cancer experts debated aspects related to the diagnosis, staging and treatment of unresectable stage III NSCLC in light of current evidence. Recent breakthroughs in immunotherapy as part of a standard therapeutic approach were also discussed. This review exposes the major conclusions obtained. RESULTS Practical recommendations for the management of unresectable stage III NSCLC were proposed, aiming to improve the pathways of diagnosis and treatment in the Portuguese healthcare system. Clinical heterogeneity of patients with stage III NSCLC hinders the development of single standardised algorithm where all fit. CONCLUSIONS A timely diagnosis and a proper staging contribute to the best management of each patient, optimizing treatment tolerance and effectiveness. The expert panel considered chemoradiotherapy as the preferable approach when surgery is not possible. Management of adverse events and immunotherapy as a consolidation therapy are also essential steps for a successful strategy.
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Affiliation(s)
- A Araújo
- Medical Oncology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - A Barroso
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal
| | - B Parente
- Hospital CUF Porto, Estrada da Circunvalação 14341, 4100-180 Porto, Portugal
| | - C Travancinha
- Instituto Português de Oncologia Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - E Teixeira
- Centro Hospitalar Lisboa Norte - Hospital Pulido Valente, Alameda das Linhas de Torres, 117 1769-001 Lisboa, Portugal; Hospital CUF Descobertas, Rua Mário Botas, 1998-018 Lisboa, Portugal; Hospital CUF Tejo, Avenida 24 de Julho 171A, 1350-352 Lisboa, Portugal
| | - F Martelo
- Hospital da Luz Lisboa, Avenida Lusíada 100, 1500-650 Lisboa, Portugal
| | - G Fernandes
- Centro Hospitalar Universitário de São João, Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - G Paupério
- Instituto Português de Oncologia Porto Francisco Gentil, Rua Dr. António Bernardino de Almeida 62, 4200-072 Porto, Portugal
| | - H Queiroga
- Centro Hospitalar Universitário de São João, Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - I Duarte
- Instituto Português de Oncologia Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - J D da Costa
- Instituto Português de Oncologia Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - M Soares
- Instituto Português de Oncologia Porto Francisco Gentil, Rua Dr. António Bernardino de Almeida 62, 4200-072 Porto, Portugal
| | - P Borralho
- Hospital CUF Descobertas, Rua Mário Botas, 1998-018 Lisboa, Portugal
| | - P Costa
- Instituto CUF Porto, Rua Fonte das Sete Bicas 170, 4460-188 Senhora da Hora, Porto, Portugal
| | - P Chinita
- Hospital do Espírito Santo de Évora, Largo do Sr. da Pobreza, 7000-811 Évora, Portugal
| | - T Almodôvar
- Instituto Português de Oncologia Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - F Barata
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal.
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Parente P, Chan BA, Hughes BGM, Jasas K, Joshi R, Kao S, Hegi-Johnson F, Hui R, McLaughlin-Barrett S, Nordman I, Stone E. Patterns of care for stage III non-small cell lung cancer in Australia. Asia Pac J Clin Oncol 2019; 15:93-100. [PMID: 30868747 DOI: 10.1111/ajco.13140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/28/2019] [Indexed: 12/25/2022]
Abstract
Stage III non-small cell lung cancer (NSCLC) makes up a third of all NSCLC cases and is potentially curable. Despite this 5-year survival rates remain between 15% and 20% with chemoradiation treatment alone given with curative intent. With the recent exciting breakthroughs in immunotherapy use (durvalumab) for stage III NSCLC, further improvements in patient survival can be expected. Most patients with stage III NSCLC present initially to their general practitioner (GP). The recommended time from GP referral to first specialist appointment is less than 14 days with treatment initiated within 42 days. Our review found that there is a shortfall in meeting these recommendations, however a number of initiatives have been established in Australia to improve timely and accurate diagnosis and treatment patterns. The lung cancer multidisciplinary team (MDT) is critical to consistency of evidence-based diagnosis and treatment and can improve patient survival. We aimed to review current patterns of care and clinical practice recommendations for stage III NSCLC across Australia and identify opportunities to improve practice in referral, diagnosis and treatment pathways.
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Affiliation(s)
- Phillip Parente
- Eastern Health Monash University, Box Hill, Victoria, Australia
| | - Bryan A Chan
- The Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,University of Queensland, St Lucia, Queensland, Australia
| | - Brett G M Hughes
- University of Queensland, St Lucia, Queensland, Australia.,The Royal Brisbane and Women's Hospital, Herston, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Kevin Jasas
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Rohit Joshi
- Calvary Central Districts Hospital, Elizabeth Vale, South Australia, Australia
| | - Steven Kao
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | | | - Rina Hui
- Westmead Hospital, Westmead, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | | | - Ina Nordman
- Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Emily Stone
- St Vincent's Hospital and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
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