Do you consider NSCLC with multistation N2 involvement appropriate for treatment with neoadjuvant chemoimmunotherapy followed by surgery?  

Interesting question and something that is frequently discussed in tumor boards. Multistation N2 patients were not included in neoadjuvant trials and hence, any adaptation of this strategy to patients with advanced N staging would not be appropriate at this time. Further, given level 1 evidence from...

This is a great question, as the reality is that while there is data for the efficacy of neoadjuvant chemoimmunotherapy followed by surgery, the current data is insufficient to tell us whether this is actually the appropriate treatment.  Neoadjuvant chemoimmunotherapy studies (such as Chec...

Fundamental principles rarely change, and multi station N2 nodes mean the tumor population has mechanisms to travel. Granted that select patients can surmount this, but it will never emerge in a randomized setting. It is an anecdote. Albain/Rusch published CRT v CRT/S showing equivalence (despite wr...

CRT gives a mixed pCR rateSeveral studies of preoperative cisplatin-based chemotherapy and radiotherapy have evaluated the pathologic response in LA-NSCLC and have demonstrated pCR rates varying from 17% to 45% Roy et al., PMID 31673516 Kappers et al., PMID 19699647 Neoadjuvant CRT (cisplatin...

Approximately 40% of patients in the NADIM II trial had multistation N2 disease. Therefore, there is precedence to consider neoadjuvant chemoimmunotherapy followed by surgery in this population. At times, this can be a safer approach, especially if the CRT field will be excessively large (e.g. LLL t...

As high-level data demonstrating which patients benefit from surgery for LA-NSCLC is lacking, I think it is useful to consider how surgery might improve outcomes over radiation-based treatment. Here are a few possibilities and my thoughts: Better local disease control? I believe this could only ...