Traitement des cancers du poumon de stade I : la radiothérapie en conditions stéréotaxiques devient-elle un nouveau standard ? Point de vue d'un chirurgien

Lobectomy with lymphadenectomy is the standard of care of patients with early stage non-small cell lung cancer, and the use of minimally invasive approaches is associated with reduced morbidity when compared with thoracotomy. Segmentectomy with lymphadenectomy seems to provide a curative effect equivalent to that of lobectomy for stage IA tumours of 2 cm or smaller, and for pure or predominant ground glass opacities. The combination of lung-sparing resections with minimally invasive approaches results in preserved pulmonary function, improved quality of life and very low morbidity. This benefit persists in so-called high-risk patients. Among patients with clinical stage IA managed with sublobar resections, more than 25% are proved to have a more advanced pathologic stage at surgery, suggesting that alternative ablative therapies would result in an incomplete resection in a similar proportion. Moreover, resection samples tumour tissue that is adequate in quantity and quality, and provides material for “research biopsies” to consolidate tissue availability for clinical trials, translational research, and in biobanks.