Radiotherapy for Unresectable Locally Advanced Non-Small Cell Lung Cancer: A Practical Multidisciplinary Approach to Challenging Scenarios from the International Association for the Study of Lung Cancer (IASLC) Advanced Radiation Technology (ART) Sub

Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease with multiple curative and palliative treatment options. Surgery and radiotherapy are the primary local treatment modalities, and their use guided by the principals of tumor resectability and patient operability. Neoadjuvant and adjuvant immunotherapy have changed the patterns of multidisciplinary management of stage III NSCLC. On behalf of the Multidisciplinary Clinical Science Committee and Advanced Radiotherapy Technology Subcommittee of the International Association for the Study of Lung Cancer (IASLC), we present five cases representing challenging scenarios for discussion. The first is strategies for optimizing staging prior to curative-intent, particularly the role of endobronchial ultrasound (EBUS). The second focuses on the role of targeted therapies in the curative-intent chemoradiotherapy paradigm. The third examines treatment approaches for elderly or comorbid patients, specifically the choice between radiotherapy or systemic therapy. The fourth considers the management of patients who do not undergo surgery after neoadjuvant systemic therapy. The fifth concerns the role of adjuvant radiotherapy following neoadjuvant therapy and surgery. Herein, we present a review of challenging clinical scenarios often encountered in thoracic multidisciplinary tumor boards.