CLICaP Guía CLICaP para el diagnóstico, tratamiento y seguimiento del cáncer de pulmón de células no pequeñas localmente avanzado

Locally advanced (stage III) Non-small-cell lung cancer (LA-NSCLC) is a heterogeneous disease that represents a challenge due to its enormous clinical, diagnostic, and therapeutic complexity. LA-NSCLC affects approximately one-third of patients, and the optimal treatment approach is most frequently multi-modal, with systemic and local therapies for local and subclinical systemic disease control. The exact sequence and modality used are debated and case-specific. The first question always approached in the management of LA-NSCLC is whether it is potentially resectable. If the patient is a candidate for surgery, preoperative treatment (chemotherapy or chemoradiotherapy (CRT)) is an option, particularly in cases with optimal pulmonary function, mediastinal tumor clearance following upfront treatment, and no requirements for pneumonectomy. However, for the remaining patients or those diagnosed with unresectable stage LA-NSCLC, platinum-based concurrent chemoradiotherapy is the standard of care (in some cases, sequential CRT could be an option). This clinical practice guideline (CPG) has been prepared by experts who have extensively reviewed the literature. It includes evaluating information related to critical studies on diagnostic strategies, including the technical capacity to stratify mediastinal lymph node involvement. Additionally, it considers information on surgical interventions, chemotherapy, and radiation therapy. It also discusses the optimal treatable areas for radiotherapy and dose fractionation. The CPG also highlights the rationale for the benefits of immunotherapies and the incursion of adjuvant-targeted therapy in patients with LA-NSCLC with driver mutations.