Diagnosis and treatment progress of stage Ⅲ resectable/potentially resectable NSCLC
10.3760/cma.j.cn112434-20230303-00048
- VernacularTitle:Ⅲ期可切除与潜在可切除非小细胞肺癌的诊疗进展
- Author:
Yingran SHEN
1
;
Jie DAI
;
Gening JIANG
;
Peng ZHANG
Author Information
1. 同济大学附属上海市肺科医院胸外科，上海 200433
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2023;39(6):379-384
- CountryChina
- Language:Chinese
-
Abstract:
Treatment of stage Ⅲ NSCLC is challenging, and the best treatment strategy is still controversial. The emergence of new therapeutic agents and philosophy also continues to redefine the range of resectable/ potentially resectable NSCLC. Resectable N2-stage Ⅲ lymph nodes are usually scattered with well-defined margins and no adhesions to surrounding structures. Neoadjuvant therapy followed by surgery has lower local recurrence rate compared to radical radiotherapy. According to current guidelines, surgical treatment is not recommended for N3-stage Ⅲ NSCLC. However, for regional N3 disease with continuous response to chemotherapy, after careful selection, surgery may worth a try. The efficacy of immunotherapy in locally advanced lung cancer has been confirmed in many prospective clinical trials. Neoadjuvant immunotherapy significantly improves major pathological remission rates and pathological complete remission rates, which allows these downstaging patients have the chance to receive surgery and thus improve their long-term prognosis. For efficacy assessment of neoadjuvant immunotherapy, pathological biopsy is more reliable than CT. In conclusion, the progress in multimodality neoadjuvant therapy will provide more surgical opportunities and better long-term prognosis for patients with potentially resectable stage Ⅲ NSCLC.
