Surgery after induction chemo or immunotherapy for locally advanced NSCLC

Lung cancer stays as the leading cause of cancer mortality worldwide accounting for 1.8 million newly diagnoses per year (13% of all cancers diagnosed) (1). Non-small-cell lung cancer (NSCLC) represents more than 80% of total lung cancer cases of which 19% are early-stage lung cancers, 25% locally-advanced and 56% of patients were diagnosed with distant metastases (2). Great interest has been placed in the treatment of NSCLC; however, while for early stage lung cancers, survival has increased and guidelines substantially agree on the therapeutic pathway, treatment, for locally-advanced NSCLC, has not been adequately standardized and survival outcomes are almost disappointing, with no remarkable improvements in the last 30 years. A wide range of treatment options are imaginable for stage III lung cancer. The 8 edition of the American Joint of Committee on Cancer’s tumor, node, and metastasis (TNM) staging system classifies locally-advanced NSCLC as IIIA, IIIB, and IIIC (3). While technical advancements increased feasibility of complex resections of locally-invasive tumors, limited evidence exists, supporting extended resections with curative intent for NSCLC-patients with mediastinal nodal disease (4,5). In stage IIIA and IIIB cancer patients, where surgery was the only treatment performed, relapse occurred in more than 80% of cases, locally in about 1/3 of patients, distantly or combined in about 2/3 of patients. Based on these evidences, multimodal care strategies should be considered.