Online first
Review paper
Published online: 2025-03-17
How to combine surgery with other therapeutic methods in lung cancer? Choosing the right patient for perioperative chemoimmunotherapy in early non-small cell lung cancer
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Abstract
Lung cancer treatment has evolved into a complex multidisciplinary challenge, offering patients across all stages access to diverse local and systemic therapies. The introduction of effective neoadjuvant, adjuvant, and peri-adjuvant protocols has significantly improved treatment outcomes. While surgery was once the primary treatment, it is now often complemented by additional therapies that enhance overall survival from pathological stage IB to IIIB. These advancements necessitate changes in resectability definitions, staging, preoperative workup, surgical safety, and the role of multidisciplinary assessment. Despite these improvements, numerous controversies persist. Identifying optimal candidates for perioperative chemoimmunotherapy remains challenging. Patients with squamous cell histology, high PD-L1 expression, EGFR/ALK wild-type tumors, and those who are smokers with good pulmonary function tests and initially resectable to the extent of lobectomy are most likely to benefit. Tailoring treatment to these characteristics may enhance outcomes and maximize benefits.
Keywords: lung cancer resectabilityneoadjuvant chemoimmunotherapymultidisciplinary team approachmediastinal staging
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