Cancers bronchiques localement avancés ou inopérables stades III : le rôle du pneumo-oncologue: Locally advanced non-small cell lung cancer

Abstract

AbstractApproximately 25 % of Non-small Cell Lung Cancer (NSCLC) present with a locally advanced disease. The stage III in the 8th edition of the TNM classification, includes heterogeneous diseases in term of initial clinical presentation and therapeutic strategy. An optimal initial staging integrating a PET/CT, EBUS mediastinal nodes exploration and an injected brain imaging is necessary. Pulmonary function test is to be systematically realized. The therapeutic strategy is decided in a multidisciplinary tumor board by an experimented team. Surgery remainspossible in stage IIIA minimal N2 disease, but has to be then preceded by a neo-adjuvant treatment. Most of the stage IIIB and IIIC NSCLC receive a radio-chemotherapy. A concurrent 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 fail or elderly patients who could not benefit from a concurrent chemotherapy, a sequential normo-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 of care, in patients with a PD-L1 expressing tumor, based on the PACIFIC trial overall survival results.© 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.