Surgery for stage III N2 non-small cell lung cancer within multimodal treatment concepts Novel neoadjuvant and adjuvant treatment strategies

Stage IIIA non-small cell lung cancer comprises an inhomogeneous group of patients with both locoregional (N1) and ipsilateral mediastinal (N2) lymph node metastasis. Close collaboration between surgeons, thoracic oncologists, and radiotherapists allows selected patients to be offered multimodal treatment with curative intent despite N2 metastasis. Individual outcomes can be further improved by integration of novel multimodal treatment options into established therapeutic strategies. Targeted therapies and antibodies for checkpoint inhibition have already gained entry into standard adjuvant lung cancer treatment. Promising results of ongoing phase III trials investigating neoadjuvant chemoimmunotherapy highlight the necessity of reviewing the role of immunomodulatory drugs in the context of operable lung cancer. Approval of corresponding agents for perioperative systemic treatment of patients with nonmetastatic lung cancer is expected in the near future.