Non-small cell lung cancer: how do experts want to be treated?

Abstract Objectives: Lung cancer is the leading cancer type among cancer deaths in the world and our country. There are some controversial issues that specialists dealing with oncology have difficulty in decision making. The aim of this study is to determine the approach of physicians of different specialties to the management of lung cancer.Methods: In this study, an on line questionnaire was applied to specialists of lung cancer. In this questionnaire there were some lung cancer scenarios created on controversial issues, each including different stages of the disease. The scenarios were based on the hypothesis that “the participating physicians had lung cancer themselves”, and expected to answer the treatment scenarios in this wise. The participants are pulmonologists, thoracic surgeons, radiation oncologists and medical oncologists. Results: Of the participating 170 physicians 45% were radiation oncologists, 24% pulmonologists, 23% thoracic surgeons and 8% medical oncologists. In the scenario, created to determine the approach to surgery in N2 disease, 45% of cases preferred surgery. It was also remarkable that surgery was preferred 16% in N3 diasease. In stage 1A2 disease, when pulmonary functions were insufficient for surgery, radiotherapy was preferred by 64% of cases. In the scenario questioning the decision about chemotherapy in T3N2 disease, cisplatin-etoposide vs paclitaxel-carboplatin options were preferred 32%, 26% respectively. The approach to solitary brain metastasis was 64% in favor of stereotactic radiotherapy after brain surgery. Immunotherapy was the preferred treatment when multipl brain metastasis occured in case with negative driver mutations and PDL1>1%. In oligometastatic disease, 97% of cases preferred surgery for both lung and metastatic side. Conclusions: Although there are guidelines in the management of lung cancer, there are still controversial issues with renewed treatment protocols in some special conditions. We believe that the results of this study will highlight these issues.