Navigating controversies in stage III NSCLC: a multidisciplinary case discussion on evolving treatment paradigms

作者：Horne A, Gomez-Randulfe I, Ford A, Milton R, Jankowska P, O'Dowd E, Greystoke A, Faivre-Finn C · 发表于：Lung cancer (Amsterdam, Netherlands) · 年份：2026 · DOI：10.1016/j.lungcan.2026.109411 · 研究领域：Lung Neoplasms、Carcinoma, Non-Small-Cell Lung、Antineoplastic Combined Chemotherapy Protocols、Humans、Male、Aged、Neoplasm Staging、Pneumonectomy、Neoadjuvant Therapy、Pathologic Complete Response

BACKGROUND: The management of stage III non-small cell lung cancer (NSCLC) has become increasingly complex, driven by advances in neoadjuvant and perioperative chemo-immunotherapy as well as targeted therapies. These evolving treatment paradigms have introduced new challenges for multidisciplinary teams (MDTs), regarding patient selection, treatment sequencing, surgical planning and definitions of operability and resectability. CASE PRESENTATION: We present a case of a 69-year-old male with cT3N2aM0 (single-station N2) adenocarcinoma NSCLC with a programmed death-ligand 1 (PD-L1) tumour proportion score of 100%. Following discussion in MDT, he received 3 cycles of neoadjuvant carboplatin, paclitaxel, and nivolumab. The initial surgical plan was for a pneumonectomy due to tumour proximity to the right main bronchus, a procedure associated with perioperative risk and long-term functional compromise. Restaging computed tomography (CT) scan demonstrated a partial response, with a 60% reduction in axial tumour dimensions. This downstaging facilitated a change in surgical plan from pneumonectomy to the less extensive right upper lobectomy, resulting in a pathological complete response (ypT0ypN0). DISCUSSION: The case was discussed during an academic webinar in August 2025. Expert faculty from respiratory medicine, thoracic surgery and medical and radiation/clinical oncology highlighted key discussion points and challenges. This included: 1) evolving definitions of operability and...