grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-46252686-7370Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2023-182-5-68-75grekov-2351Research ArticleОБЗОРЫREVIEWSАнализ современных международных клинических рекомендаций по лечению больных немелкоклеточным раком легкого III стадииThe analysis of current international recommendations for the treatment of patients with stage III non-small cell lung cancerhttps://orcid.org/0000-0001-8698-7018АкоповА. Л.AkopovA. L.

Акопов Андрей Леонидович - доктор медицинских наук, профессор, руководитель отдела торакальной хирургии НИИ хирургии и неотложной медицины.

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Akopov Andrey L. - Dr. of Sci. (Med.), Professor, Head of the Department of Thoracic Surgery of the Research Institute of Surgery and Emergency Medicine.

6-8, L’va Tolstogo str., Saint Petersburg, 197022

akopovand@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияPavlov UniversityRussian Federation20231905202418256875Copyright © Акопов А.Л., 20242024Акопов А.Л.Akopov A.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/2351

Развитие системного противоопухолевого лечения, таргетной терапии и терапии ингибиторами иммунных контрольных точек (ИКТ), изменило результаты терапии и прогноз больных местнораспространенным немелкоклеточным раком легкого (НМКРЛ). Современные рекомендации предусматривают разделение таких больных на потенциально резектабельных и нерезектабельных, причем такое разделение далеко не всегда соответствует IIIа, IIIв или IIIс стадии заболевания. Лечение резектабельных опухолей рекомендуется начать с неоадьювантной химиоиммунотерапии (ХИТ), и в последующем проводить хирургическое вмешательство, направленное на радикальное удаление опухоли только больным, ответившим на лечение. При нерезектабельном раке лучшим подходом считается проведение одновременной химиолучевой терапии (ХЛТ) с последующей адьювантной терапией ИКТ, а роль хирургических вмешательств сводится только к хирургии спасения – удалению резидуальной опухоли или локального рецидива после самостоятельного нехирургического лечения.

Такой подход к лечению больных III стадией НМКРЛ вряд ли может полностью удовлетворить специалистов и пациентов - не существует полного консенсуса в определении термина «резектабельность»; отрицается сама возможность перевода нерезектабельной опухоли в резектабельную в результате неоадьювантного лечения, что противоречит клинической практике. Цель статьи – критический анализ существующих рекомендаций о роли хирургического подхода  как этапа комплексного лечения НМКРЛ III стадией с точки зрения хирурга.

The development of systemic antitumor treatment, targeted therapy and immune checkpoint inhibitor therapy (ICI) has changed the treatment outcome and prognosis for locally advanced non-small cell lung cancer (NSCLC). Modern recommendations provide for the division of such patients into potentially resectable and unresectable, and such division does not always correspond to stage IIIa, IIIb or IIIc of the disease. The treatment of resectable tumors is recommended to start with neoadjuvant chemoimmunotherapy (CIT), followed by surgical intervention aimed at radical tumor removal only in patients who respond to treatment. For unresectable tumors, the best approach is considered to be simultaneous chemoradiation therapy (CRT) followed by adjuvant ICI therapy, and the role of surgical interventions is limited to salvage surgery – residual tumor or local relapse removal after non-surgical self-treatment.

This approach to the treatment of patients with stage III NSCLC is unlikely to fully satisfy specialists and patients – there is no complete consensus on the definition of the term «resectability»; the possibility of converting an unresect able tumor into a resectable one as a result of neoadjuvant treatment is denied, which is contrary to clinical practice. The objective of the article was the critical analysis of existing recommendations on the role of the surgical approach as a stage of complex treatment of stage III NSCLC from the surgeon’s point of view.

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The authors declare that there are no conflicts of interest present.