Surgical treatment outcomes in patients with non-small cell lung cancer treated with neoadjuvant systemic therapy. A pilot single-center retrospective study

Objective: to evaluate the effectiveness of surgical treatment in patients with stage II–III non-small cell lung cancer, who received neoadjuvant systemic chemotherapy or chemoimmunotherapy, as well as to assess radiological and pathological tumor responses to drug therapy. Material and Methods. The study included 22 patients with stage IIB, IIIA and IIIB non-small cell lung cancer, who received neoadjuvant systemic therapy in the period from May 2022 to June 2024. Of these patients, 12 received platinum-containing chemotherapy (neoChT group) and 10 received chemoimmunotherapy including pembrolizumab (neoChIT group). The median number of therapy courses was 4 in each group. Radical surgery was performed in 7 patients from the neoChIT group and in 12 patients from the neoChT group. Results. Radiological complete response was observed in 1 patient from the neoChIT group, and partial response in 6 patients from the neoChIT group and in 7 patients from the neoChT group. Pathological complete response was observed in 3 patients from the neoChIT group and in 2 patients from the neoChT group. Lobectomy was the most common type of lung resection in both groups: in 5 patients from the neoChIT group and in 10 from the neoChT group. The majority of patients (60 %, 9/15) underwent sleeve lobectomies. Postoperative complications were recorded in 2 patients from the neoChIT group and in 4 from the neoChT group. Postoperative mortality in the group of radical surgeries was 5.3 % (1 out of 19). The follow-up period was 25.2 months. All patients who underwent surgery, excluding postoperative mortality, are alive. The 2-year recurrence-free survival rate was 77.4 ± 15.2 %. Disease progression 5 and 16 months after surgery was observed in 2 patients from the neoChT, respectively. Conclusion. Neoadjuvant systemic therapy is a safe and promising approach in the treatment of patients with locally advanced non-small cell lung cancer. The surgical component is characterized by a high frequency of organ-preserving interventions, a non-increased frequency of complications and satisfactory long-term results. The preliminary data obtained are comparable with the available data in the world literature. Unambiguous conclusions require further accumulation of experience and more extensive research.