Perioperative Neoadjuvant chemo IO in thoracic solid tumours

Authored by Andrea Billè, published on 2026-04-10 17:22:06.0

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).

Insert T N M variables in the algorithm to have the stage

Osarogiagbon RU, Van Schil P, Giroux DJ, Lim E, Putora PM, Lievens Y, Cardillo G, Kim HK, Rocco G, Bille A, Prosch H, Vásquez FS, Nishimura KK, Detterbeck F, Rami-Porta R, Rusch VW, Asamura H, Huang J; Members of the N-Descriptors Subcommittee. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Overview of Challenges and Opportunities in Revising the Nodal Classification of Lung Cancer. J Thorac Oncol. 2023 Apr;18(4):410-418. doi: 10.1016/j.jtho.2022.12.009. Epub 2022 Dec 24. PMID: 36572339; PMCID: PMC10065917. Argentieri G, Valsecchi C, Petrella F, Jungblut L, Frauenfelder T, Del Grande F, Rizzo S. Implementation of the 9th TNM for lung cancer: practical insights for radiologists. Eur Radiol. 2025 Jul;35(7):4395-4402. doi: 10.1007/s00330-024-11345-8. Epub 2025 Jan 17. PMID: 39825171; PMCID: PMC12165876.
- 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

tos privacy Implementation of the 9th TNM for lung cancer: practical insights for radiologists The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Overview of Challenges and Opportunities in Revising the Nodal Classification of Lung Cancer 9th TNM cards Cancer UK Reference