[Early stages of non small cell lung cancer (I. II. IIIA). What is the best therapeutic strategy?].
NSCLC early stages (I, II, IIIA) may be offered surgery, but the possibilities of resection and cure are decreasing with increasing stages. Surgery may be part of combined therapeutic strategies: it can be sufficient, or benefit neo-adjuvant modalities. Post-operative risk of death is acceptable, but rates following right pneumonectomy are important, and appear favored by neo-adjuvant chemotherapy. However, in case of down-staging, neo-adjuvant chemotherapy offers a better prognosis and can limit the extent of the resection, which may prove beneficial especially for the right side. Surgery is diagnostic and therapeutic in 45% of patients. So neo-adjuvant chemotherapy is theorically available in 55%, but finally remains performed in 40% of these patients (mainly stage IIIA). Randomized trials demonstrated a beneficial effect in case of early NSCLC stages. The improvement is certain for stage II concerning both the quality of resection and the survival. In case of NSCLC stage I, neo-adjuvant chemotherapy is still a matter of debate.
Riquet
M
M
Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, Paris, France. marc.riquet@hop.egp.ap-hop-paris.fr
Berna
P
P
D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging