[Which treatments should be proposed in resectable stage III cancers?]

The results of surgery alone or associated with an adjuvant treatment, chemo- and/or radio-therapy, in the management of stage III resectable non-small cell lung cancer (NSCLC), are disappointing; with survival rates at 5 years generally lesser than 20% and many local and distant relapses. They justified the development of phase II trials that showed the feasibility of the chemotherapy and neo-adjuvant chemo-radiotherapy with high rates of response and acceptable toxicity. The three phase III studies with induction chemotherapy gave contradicting results; two of them were on small cohorts and presented methodological biases. Regarding pre-surgery chemo-radiotherapy, there is presently no published phase II trial and a recent phase II trial was in favour of a concomitant mode with bifractioned irradiation. The new targeted therapeutic agents do not yet have an indication in this field. In the particular case of resectable tumours of the apex invading the wall, so-called Pancoast, neo-adjuvant chemoradiotherapy followed by surgical resection has become the treatment of choice. The place of chemotherapy, radiotherapy and even surgery in the treatment of resectable stage III NSCLC remains to be defined and the inclusion of patients in randomised clinical trials is recommended.