Applicability of Western Lung Cancer Guidelines in LMICs

Abstract (English)

Lung cancer remains the leading cause of cancer-related mortality worldwide. It is the second most common cancer in men and the third most common cancer in women, although the gender gap has narrowed over the past decade because of stable incidence rates in men and a marked increase among women. Smoking remains the principal risk factor for lung cancer.
Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers. Prognosis is strongly associated with the stage at diagnosis and the availability of appropriate treatment. Five-year survival rates now approach 80% for stage I disease but remain substantially lower for stage II-III disease, ranging from approximately 15% to 60%.
Advanced NSCLC has become increasingly heterogeneous due to major therapeutic advances. Median overall survival may exceed 40 months in patients with EGFR-mutated tumors treated with third-generation tyrosine kinase inhibitors and can remain unreached in selected patients with ALK-rearranged disease receiving modern targeted therapies. In patients without actionable molecular alterations, median overall survival typically ranges from 15 to 30 months with contemporary chemoimmunotherapy, depending on histology and PD-L1 expression.
Comprehensive molecular profiling is now recommended for advanced non-squamous NSCLC and is increasingly relevant in earlier-stage disease, particularly for EGFR and ALK alterations. Assessment of PD-L1 expression is also considered an essential component of treatment decision-making in patients with NSCLC.
This presentation reviews recent Western radiotherapy guidelines for the use of external beam radiotherapy in both non-small cell and small-cell lung cancer, from early-stage to metastatic disease, and discusses their applicability in low- and middle-income countries (LMICs). Systemic therapies are discussed only when they directly impact radiotherapy indications or treatment strategies.