[Indications for surgery in non-small cell lung cancer with lymph node invasion]

[Chemo-radiotherapy before surgery in stage III non-small-cell lung cancer]

Surgery is often performed when N2 non-small-cell lung cancer can be resected by lobectomy since the publication of the "EORTC 08941" and "RTOG 9309" trials (the latter showed high mortality rate after pneumonectomy). The usefulness of adjuvant chemotherapy has been proved, and that of modern adjuvant radiotherapy is suspected, but neoadjuvant chemotherapy is also routinely performed in France. Neoadjuvant chemo-radiotherapy is more accepted in the USA and northern Europe. Four randomized trials have not shown any advantage in comparison with neoadjuvant chemotherapy, due to increased postoperative mortality, but retrospective studies in specialized centers have demonstrated low operative risks, even after high-dose radiation, or pneumonectomy. In the case of invasive apical tumors, neoadjuvant chemo-radiotherapy is recommended. In case of local recurrence without distant recurrence after exclusive chemo-radiotherapy, curative surgery may be envisaged.