ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

The European Respiratory Society (ERS), in collaboration with the European Society of Thoracic Surgery (ESTS), has proposed to bring together multidisciplinary experts on functional evaluation of lung cancer patients to draw up recommendations in order to provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy.The subject was divided in different topics, which were in turn assigned to at least two experts. The authors searched the literature according to their own strategies, no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted by the entire expert panel. The evidence supporting each recommendation was summarized, and graded as described by the Scottish intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk-stratification of the lung resection candidatesemphasizing cardiologic evaluation, systematic carbon monoxide lung diffusion capacity and exercise testing. Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before radio-chemotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialized settings by multidisciplinary teams.