Lung Multidisciplinary Team Decision-Making Challenges in Perioperative NSCLC: Borderline Resectability and Discordant Responses Through the Lens of Real-World Scenarios
9 affiliations
- 1Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- 2School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- 3Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
- 4Pneumology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- 5Radiation Oncology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- 6Pathology Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- 7Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- 8Department of Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- 9Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
Abstract
Background: Resectable or potentially resectable stage II–III NSCLC encompasses heterogeneous clinical scenarios. The introduction of neoadjuvant and perioperative strategies has expanded treatment options while increasing the complexity of multidisciplinary decision-making and the need to reassess treatment pathways over time. Methods: We conducted a single-centre retrospective descriptive analysis of 101 patients with clinical or pathological stage II–III NSCLC discussed within our thoracic multidisciplinary team (MDT) between 2023 and 2025. Using MDT meeting records supplemented by medical records, we analysed decision-making trajectories and the main reasons for changes in treatment strategy. Results: Three major decision points emerged: selection of preoperative treatment, reassessment of resectability and operability after preoperative treatment, and postoperative assessment of recurrence risk and feasibility of adjuvant treatment. Treatment pathways were modified according to disease response or progression, surgical feasibility, comorbidities, treatment-related toxicity, pathological findings, and postoperative recovery. Particularly challenging scenarios included heterogeneous stage II disease, borderline resectability, and discordant responses after induction therapy. Conclusions: Perioperative management of stage II–III NSCLC requires dynamic, longitudinal multidisciplinary decision-making rather than a single treatment decision at diagnosis. Integrated reassessment of clinical, pathological, and molecular disease characteristics, treatment response, patient fitness, and surgical feasibility may help individualise treatment pathways.
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BibTeX
@article{cortinovis2026lung,
title = {{Lung Multidisciplinary Team Decision-Making Challenges in Perioperative NSCLC: Borderline Resectability and Discordant Responses Through the Lens of Real-World Scenarios}},
author = {Diego Luigi Cortinovis and Stefania Canova and Maria Ida Abbate and Francesca Colonese and Luca Sala and Alice Ilari and Sara Mambrito and Piergiorgio Solli and Giovanni Leuzzi and Fabrizio Luppi and Stefano Arcangeli and Francesca Bono and Cammillo Roberto Talei Franzesi and Luca Guerra and Francesco Petrella},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18203377},
url = {https://www.mdpi.com/2072-6694/18/20/3377},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Lung Multidisciplinary Team Decision-Making Challenges in Perioperative NSCLC: Borderline Resectability and Discordant Responses Through the Lens of Real-World Scenarios
AU - Diego Luigi Cortinovis
AU - Stefania Canova
AU - Maria Ida Abbate
AU - Francesca Colonese
AU - Luca Sala
AU - Alice Ilari
AU - Sara Mambrito
AU - Piergiorgio Solli
AU - Giovanni Leuzzi
AU - Fabrizio Luppi
AU - Stefano Arcangeli
AU - Francesca Bono
AU - Cammillo Roberto Talei Franzesi
AU - Luca Guerra
AU - Francesco Petrella
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18203377
UR - https://www.mdpi.com/2072-6694/18/20/3377
AB - Background: Resectable or potentially resectable stage II–III NSCLC encompasses heterogeneous clinical scenarios. The introduction of neoadjuvant and perioperative strategies has expanded treatment options while increasing the complexity of multidisciplinary decision-making and the need to reassess treatment pathways over time. Methods: We conducted a single-centre retrospective descriptive analysis of 101 patients with clinical or pathological stage II–III NSCLC discussed within our thoracic multidisciplinary team (MDT) between 2023 and 2025. Using MDT meeting records supplemented by medical records, we analysed decision-making trajectories and the main reasons for changes in treatment strategy. Results: Three major decision points emerged: selection of preoperative treatment, reassessment of resectability and operability after preoperative treatment, and postoperative assessment of recurrence risk and feasibility of adjuvant treatment. Treatment pathways were modified according to disease response or progression, surgical feasibility, comorbidities, treatment-related toxicity, pathological findings, and postoperative recovery. Particularly challenging scenarios included heterogeneous stage II disease, borderline resectability, and discordant responses after induction therapy. Conclusions: Perioperative management of stage II–III NSCLC requires dynamic, longitudinal multidisciplinary decision-making rather than a single treatment decision at diagnosis. Integrated reassessment of clinical, pathological, and molecular disease characteristics, treatment response, patient fitness, and surgical feasibility may help individualise treatment pathways.
SN - 2072-6694
ER -