ERS/ESTS clinical guidelines on the fitness of patients for radical treatment of lung cancer (surgery and chemo-radiotherapy)

SUMMARY. Collaboration of a multidisciplinary team of experts on the functional evaluation of patients with lung cancer was facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on their fitness for surgery and chemo-radiotherapy. The subject was divided into various different topics, each of which was then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature Review and compiled draft reports on each topic, which were then reviewed, discussed and voted on 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 candidates, with emphasis on the cardiological evaluation, forced expiratory volume in 1 s (FEV1), systematic carbon monoxide lung diffusion capacity (DLCO) and exercise testing. In contrast to lung resection, for which the scientific evidence is more robust, it was not possible to recommend any specific test, cut-off value, or algorithm for chemo-radiotherapy, due to the lack of data. It is highly recommended that patients with lung cancer should be managed in specialized units by experienced multidisciplinary teams. Pneumon 2010, 23(1):80-102.