ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

TLDR

The ERS/ESTS collaboration produced updated guidelines recommending that lung cancer patients be managed in specialised multidisciplinary settings and providing clear criteria for fitness to undergo surgery or chemo‑radiotherapy. Guidelines were developed by dividing topics among at least two experts, conducting literature searches, drafting and voting on recommendations, grading evidence per Scottish Intercollegiate Guidelines Network criteria, and assembling a functional risk‑stratification algorithm for lung resection candidates. The resulting recommendations include a risk‑stratification algorithm for lung resection based on cardiology, spirometry, DLCO, and exercise testing, while no specific pre‑chemo‑radiotherapy tests or cut‑offs could be advised due to insufficient evidence.

Abstract

A collaboration of multidisciplinary experts on the functional evaluation of lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy. The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk stratification of the lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide lung diffusion capacity and exercise testing. Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialised settings by multidisciplinary teams.