Multimodality approach for locally advanced lung cancer: when is surgery most beneficial?

Stage III non-small cell lung cancer (NSCLC) is a complex and challengingdisease due to its variability and the absence of standardized treatment protocols. Thisstudy aimed to investigate the role of surgical resection as part of a multimodal treatmentapproach to improve overall survival (OS) and disease-free survival (DFS) in resource-limited settings.

The medical records of 309 patients who underwent surgery for confirmed primary lung cancer at the King Hussein Cancer Center (KHCC) in Amman, Jordan, between 2016 and 2022 were reviewed. 59 of them diagnosed with Stage III NSCLC underwent curative surgeries. Patients were grouped into three categories: surgery alone, neoadjuvant therapy followed by surgery, and surgery combined with adjuvant therapy. Demographic, clinical, and survival data were statistically analyzed to compare the outcomes across these groups.

The study cohort consisted predominantly of males (86.4%), withadenocarcinoma being the most common histological subtype (54.2%). Patients whounderwent surgery alone had the lowest recurrence rate and highest three-year OS andDFS rates (66.7%). Improved OS and DFS were observed in patients with pN0 status andno evidence of lymphovascular invasion (LVI). Minimally invasive surgical approaches suchas VATS were associated with better perioperative outcomes than open surgery.

Surgical resection, particularly when achieving negative margins (R0) inpatients with N0 disease, is critical for improving survival in patients with Stage IIINSCLC. Multimodal strategies can enhance these benefits further. However, challengesrelated to healthcare access in resource-limited settings highlight the need for customizedtreatment protocols and broader access to advanced medical therapies.