Quoi de neuf dans les stades précoces ?

The respective position of chemotherapy and surgery for early stage non small cell lung cancer (NSCLC) remains controversial. Several recent trials studied pre- and/or postoperative chemotherapy. So, the S9900 trial failed to show a survival advantage, probably due to the early stop of accrual. Updated results of the JBR-10 trial confirmed the interest of this strategy, with notably an advantage for stage II NSCLC and for tumors of at least 4cm, and no excess of deaths by intercurrent causes at long term with adjuvant chemotherapy. The NATCH study compared surgery to chemotherapy (pre- and post-operative), with no comparison between the two arms of chemotherapy. Many early stages were included, which may have contributed to the negative results of the trial. At last, the IFCT 0002 trial compared an exclusive pre-operative chemotherapy strategy to a preand post-operative chemotherapy strategy. Survival results did not differ between the two arms, but a best compliance was reported with chemotherapy given before surgery. Pre- and post-operative chemotherapy remain options, with a higher level of evidence for postoperative chemotherapy, but also advantages in favour of the preoperative strategy.