Perioperative Neoadjuvant chemo IO in thoracic solid tumours

Authored by Andrea Billè, published on 2026-05-28 07:14:46.0

Resectability Matrix in the ERA of Immunotherapy There are several guidelines and the new TNM 9th edition available but none helps to navigate about different options in the Neoadjuvant setting, Adjuvant setting or Perioperative setting. Based on stage options should be objectively compared. There is no consensus reached for some stage features. Resectability decision making is key for patient to be eligible for chemo Immunotherapy. There are guidelines but there is no algorithm to help tumour board or surgeons to define resectability in N2 category or locally advanced cancer (T3 / T4).

  1. Insert T N M variables in the algorithm to have the stage
    Staging using TNM is foundational to all downstream treatment selection in thoracic oncology. IASLC/AJCC TNM updates support the approach of deriving stage from T/N/M descriptors, though routine clinical use remains anchored to AJCC 8th edition in many settings with evolving 9th-edition adoption.
    • Stage I
      • Surgery
        https://www.cancerresearchuk.org/about-cancer/lung-cancer/stages-types/stage-1 Fit patients with good performance status ) to 1 can have an operation
        • Minimally invasive surgery: VATS or robotic surgery
          • Follow up and Surveillance
          • If upstaged consider adjuvant treatment
            10% of patients after surgery are upstaged
    • Stage II and III
      • Chemo IO neoad options
        • Surgery
      • Not fit or resectable
        • Chemo or RT or IO
      • upfront surgery
        • adjuvant treatment
    • Stage IV
      • Chemo and or IO and radiotherapy in selected cases
        • Salvage surgery at the end of treatment id low volume residual disease
tosprivacyImplementation of the 9th TNM for lung cancer: practical insights for radiologistsThe International Association for the Study of Lung Cancer Lung Cancer Staging Project: Overview of Challenges and Opportunities in Revising the Nodal Classification of Lung Cancer9th TNM cardsCancer UKReference