Radiotherapy for Unresectable Locally Advanced NSCLC: A Practical Multidisciplinary Approach to Challenging Scenarios From the International Association for the Study of Lung Cancer Advanced Radiation Technology Subcommittee.

[INTRODUCTION] Stage III NSCLC is a heterogeneous disease with multiple curative and palliative treatment options. Surgery and radiotherapy are the primary local treatment modalities, and their use is guided by the principals of tumor resectability and patient operability. Neoadjuvant and adjuvant immunotherapies have changed the patterns of multidisciplinary management of stage III NSCLC.

[METHODS] On behalf of the Multidisciplinary Clinical Science Committee and Advanced Radiotherapy Technology Subcommittee of the International Association for the Study of Lung Cancer, we present five cases representing challenging scenarios for discussion.

[RESULTS] The first is strategies for optimizing staging before curative intent, particularly the role of endobronchial ultrasound. The second focuses on the role of targeted therapies in the curative-intent chemoradiotherapy paradigm. The third evaluates treatment approaches for elderly or comorbid patients, specifically the choice between radiotherapy and systemic therapy. The fourth considers the management of patients who do not undergo surgery after neoadjuvant systemic therapy. The fifth concerns the role of adjuvant radiotherapy after neoadjuvant therapy and surgery.

[CONCLUSIONS] Herein, we present a review of challenging clinical scenarios often encountered in thoracic multidisciplinary tumor boards.