Traitements adjuvants et néo-adjuvants des stades précoces : la question est elle résolue ?

Platinum based perioperative chemotherapy is actually the standard of care in stage II - IIIa non-small cell lung cancer (NSCLC). A benefit may also be seen in stage IB NSCLC with tumors of more than 4 cm of diameter. Perioperative chemotherapy improves 5-year survival of 4 to 8 %. This benefit is mainly proved by postoperative chemotherapy trials. Nevertheless, preoperative chemotherapy has advantages : a better tolerance, an estimation of tumor chemo sensibility, without an increased postoperative morbymortality. However pTNM and pathological tumor analyses are modified. Indications of post-operative radiotherapy are limited. In early stage NSCLC (stage I-II), radiotherapy worsens survival. Radiotherapy is routinely achieved in NSCLC with parietal tumor invasion and incomplete tumor resection. Treatment of stage III N2 NSCLC remains controversy. No treatment strategy has proved superiority and different options have to been discussed : surgery followed by adjuvant chemotherapy, neoadjuvant chemotherapy followed by surgery or exclusive concomitant radio-chemotherapy. Several biomarkers are studied to better describe the indications of perioperative chemotherapy: recognize groups of patients with a worse prognosis and distinguish chemosensibility of the tumor.