Place de la chirurgie dans le traitement du CBNPC localement avancé

Abstract

The management of locally advanced non-small cell lung cancer (NSCLC), particularly stage III disease, remains a major therapeutic challenge due to its anatomical heterogeneity and the lack of a universal definition for resectability. In recent years, multi-modal strategies—especially neoadjuvant chemoimmunotherapy—have redefined the role of surgery in this complex setting.

Recent data from the CheckMate 816, AEGEAN, and CheckMate 77T trials have shown that adding immunotherapy to neoadjuvant chemotherapy significantly improves pathological complete response rates and event-free survival. These findings support broader surgical indications, even for patients initially deemed unresectable.

Conversion surgery, performed after a favorable response to induction therapy, and salvage surgery, indicated for persistent or recurrent locoregional disease after nonsurgical treatment, both represent curative options in carefully selected patients. These approaches require meticulous evaluation and high-level surgical expertise.

In oligometastatic disease, aggressive local treatment—including resection of the primary tumor and local control of metastases—can lead to significantly improved survival outcomes. Emerging evidence from prospective trials supports the proactive role of surgery in such cases.