IASLC Multidisciplinary Recommendations for Pathologic Assessment of Lung Cancer Resection Specimens After Neoadjuvant Therapy

William D. Travis*, Sanja Dacic, Ignacio Wistuba, Lynette Sholl, Prasad Adusumilli, Lukas Bubendorf, Paul Bunn, Tina Cascone, Jamie Chaft, Gang Chen, Teh Ying Chou, Wendy Cooper, Jeremy J. Erasmus, Carlos Gil Ferreira, Jin Mo Goo, John Heymach, Fred R. Hirsch, Hidehito Horinouchi, Keith Kerr, Mark KrisDeepali Jain, Young T. Kim, Fernando Lopez-Rios, Shun Lu, Tetsuya Mitsudomi, Andre Moreira, Noriko Motoi, Andrew G. Nicholson, Ricardo Oliveira, Mauro Papotti, Ugo Pastorino, Luis Paz-Ares, Giuseppe Pelosi, Claudia Poleri, Mariano Provencio, Anja C. Roden, Giorgio Scagliotti, Stephen G. Swisher, Erik Thunnissen, Ming S. Tsao, Johan Vansteenkiste, Walter Weder, Yasushi Yatabe

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review


Currently, there is no established guidance on how to process and evaluate resected lung cancer specimens after neoadjuvant therapy in the setting of clinical trials and clinical practice. There is also a lack of precise definitions on the degree of pathologic response, including major pathologic response or complete pathologic response. For other cancers such as osteosarcoma and colorectal, breast, and esophageal carcinomas, there have been multiple studies investigating pathologic assessment of the effects of neoadjuvant therapy, including some detailed recommendations on how to handle these specimens. A comprehensive mapping approach to gross and histologic processing of osteosarcomas after induction therapy has been used for over 40 years. The purpose of this article is to outline detailed recommendations on how to process lung cancer resection specimens and to define pathologic response, including major pathologic response or complete pathologic response after neoadjuvant therapy. A standardized approach is recommended to assess the percentages of (1) viable tumor, (2) necrosis, and (3) stroma (including inflammation and fibrosis) with a total adding up to 100%. This is recommended for all systemic therapies, including chemotherapy, chemoradiation, molecular-targeted therapy, immunotherapy, or any future novel therapies yet to be discovered, whether administered alone or in combination. Specific issues may differ for certain therapies such as immunotherapy, but the grossing process should be similar, and the histologic evaluation should contain these basic elements. Standard pathologic response assessment should allow for comparisons between different therapies and correlations with disease-free survival and overall survival in ongoing and future trials. The International Association for the Study of Lung Cancer has an effort to collect such data from existing and future clinical trials. These recommendations are intended as guidance for clinical trials, although it is hoped they can be viewed as suggestion for good clinical practice outside of clinical trials, to improve consistency of pathologic assessment of treatment response.

Original languageEnglish
Pages (from-to)709-740
Number of pages32
JournalJournal of Thoracic Oncology
Issue number5
Publication statusPublished - May 2020

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