Allaeys Toon, Berzenji Lawek, Van Schil Paul E
Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Drie Eikenstraat 655, B-2650 Edegem, Antwerp, Belgium.
Cancers (Basel). 2021 May 26;13(11):2603. doi: 10.3390/cancers13112603.
Multimodality therapy for locally advanced non-small cell lung cancer (NSCLC) is a complex and controversial issue, especially regarding optimal treatment regimens for patients with ipsilateral positive mediastinal nodes (N2 disease). Many trials investigating neoadjuvant immunotherapy and targeted therapy in this subpopulation have shown promising results, although concerns have risen regarding surgical feasibility. A thorough literature review was performed, analyzing all recent studies regarding surgical morbidity and mortality. Despite the fact that two major trials investigating this subject were terminated early, the overall consensus is that surgical management seems feasible. However, dissection of hilar vessels may be challenging due to hilar fibrosis. Further research is necessary to identify the role of surgery in these multimodality treatment regimens, and to define matters such as the optimal treatment regimen, the dosage of the different agents used, the interval between induction therapy and surgery, and the role of adjuvant therapy.
局部晚期非小细胞肺癌（NSCLC）的多模态治疗是一个复杂且有争议的问题，尤其是对于同侧纵隔淋巴结阳性（N2期疾病）患者的最佳治疗方案。许多针对该亚组患者进行新辅助免疫治疗和靶向治疗的试验都显示出了有前景的结果，尽管人们对手术可行性有所担忧。我们进行了全面的文献综述，分析了所有关于手术发病率和死亡率的近期研究。尽管两项针对该主题的主要试验提前终止，但总体共识是手术治疗似乎是可行的。然而，由于肺门纤维化，肺门血管的解剖可能具有挑战性。有必要进行进一步研究，以确定手术在这些多模态治疗方案中的作用，并明确诸如最佳治疗方案、所用不同药物的剂量、诱导治疗与手术之间的间隔以及辅助治疗的作用等问题。
