Non-small cell lung cancer: how do experts want to be treated?

Aim: To determine the approach of physicians of different specialties, dealing with oncology, to the management of lung cancer. Material-Method: In this prospective online questionnaire study, questions were asked over the disease scenarios created on controversial issues, each including a different stage of the disease. The scenarios were based on the hypothesis that the participating physicians had lung cancer. They were asked which treatment they would prefer, if the patient were themselves. Data were analyzed by SurveyMonkey questionnaire system. Results: Of the participating 170 physicians 45% were radiation oncologists, 24% pulmonologists, 23% thoracic surgeons and 8% medical oncologists. In the scenario, created to determine the approach to surgery in N2 disease, 45% of cases preferred surgery, contrary to the literature. It was also remarkable that surgery was preferred 16% in N3 disease. In Stage 1A2 disease, when pulmonary functions were insufficient for surgery, radiotherapy was preferred by 64% cases. In the scenario questioning the decision about chemotherapy in the T3N2 disease, cisplatin-etoposide and paclitaxel-carboplatin options were preferred 32%, 26% respectively. The approach to solitary brain metastasis was 64% in favor of stereotactic radiotherapy after brain surgery. Immunotherapy was the preferred treatment when multiple brain metastasis occured in case with negative driver mutations and PDL1>1%. In oligometastatic disease, 97% of cases preferred surgery for both lung and metastasis. Conclusion: Although there are guidelines in the management of lung cancer, there are controversial issues with renewed treatment protocols in some special cases. We believe that the results of our study will highlight these issues.