Chimiothérapie péri-opératoire des cancers bronchiques non à petites cellules

Surgery is the cornerstone of treatment for patients with early stage non-small cell lung cancer (NSCLC). The high incidence of relapse, local and distant, has led to the development of peri-operative strategies aimed at improving disease control after surgical resection. Numerous randomised trials have evaluated the benefits of induction or adjuvant treatments with radiotherapy and/or chemotherapy. In recent years solid data have allowed us to validate the role of cisplatin as adjuvant treatment of stage II and III NSCLC. On the other hand, even if the majority of large randomised trials of induction chemotherapy have not shown significant benefit, this strategy offers theoretical advantages over adjuvant chemotherapy, notably an improvement in treatment observance, a putative for better resectability and a pathological evaluation of the efficacy of the treatment. This review summarises most of the pertinent data on adjuvant and neo-adjuvant chemotherapy, discusses the pros and cons of each strategy, and puts forward current recommendations and expected future developments.