Cancers bronchiques localement avancés ou inopérables: rôle de l’oncologue

Abstract

Approximately 30% of Non-small Cell Lung Cancer (NSCLC) present with a locally advanced disease. This stage includes heterogeneous diseases in term of initial clinical presentation and therapeutic strategy. An optimal initial staging integrating a PET/CT and an injected brain imaging is necessary. Pulmonary function test is to be systematically realized. The therapeutic strategy is decided in a multidisciplinary board within an experimented team. Surgery is a possible option in stage IIIAN2 disease and has to be then systematically preceded by a neo-adjuvant treatment. Most of the stage IIIB and IIIC NSCLC receive a radio-chemotherapy. A concomitant plan is to be favored to a sequential plan. Platinum doublets comprise most standard chemotherapy regimens and must be started as early as possible. For the patients who could not benefit from a concomitant chemotherapy, a sequential normo-fractionnated or hypo-fractionnated radiotherapy, or even a single chemotherapy are possible alternatives. After radio-chemotherapy, a consolidation systemic treatment by durvalumab, a checkpoint inhibitor, is currently a standard on the basis of the outcomes of the PACIFIC trial.