Definition of resectable stage III non-small cell lung cancer: A systematic review from EORTC lung cancer group

Background: Stage III non-small cell lung cancer (NSCLC) is a heterogenous disease requiring a multimodality treatment approach. For resectable stage III NSCLC, treatments incorporating surgery might be beneficial, however, a definition on resectable disease is lacking. The European Organization for the Treatment and Research of Cancer (EORTC) Lung Cancer Group initiative aims to provide a uniform definition of resectable stage III NSCLC. As part of this initiative, we conducted a systematic review to identify definitions on resectability; the medical specialties involved for making the decision and the required work-up aiding the decision. Methodology: Studies were included if they provided data or definitions on resectability in stage III NSCLC and were published in English, Dutch, or French between 2005- 2022. Results: Out of 70 eligible articles, 46 provided tumour characteristics determining resectability. Factors against resection included: N3 or bulky N2 disease and locally invasive tumours. Factors favouring resection included N2-single station involvement and cT3N1. It remained unclear whether N2-multiple station and cT4N0-1 without invasion were defined as resectable. A multidisciplinary board including a thoracic surgeon, a medical (pneumo)oncologist and a radiation oncologist were involved in the decision in 95% of studies. PET-CT was considered standard in 70% and brain MRI/CT in 89% of the studies. A pathological mediastinal nodal confirmation was mandatory in 80% of the studies. Conclusions: This systematic literature review highlights tumour characteristics related to resectability, the specialties responsible for the decision and the most appropriate staging work-up in stage III NSCLC.