INITIAL PROCEDURE IN STAGE-III NONSMALL CELL-CARCINOMA

In a number of cases, surgery is carried out as the initial procedure in Stage III non small cell carcinoma. For those with Stage IIIA surge ry is the initial procedure performed by practically all teams for Sta ge T-3 chest wall and T-2 bronchial stump in patients who have non evi dence of N-2. In Stage IIIA N-2 which is histologically confirmed by m ediastinoscopie or thoracoscopy surgery is the initial procedure in ce rtain cases if the local conditions are ''favourable''. The majority o f surgical teams however prefer to operate after neo-adjuvant therapy whose long term efficacy still remains to be shown in a formal study. Stage IIIB consists of a very heterogeneous group in whom surgery can be carried out as an initial procedure in a limited number of cases su ch as involvement of the left auricle, the proximal pulmonary artery, the superior vena cava, the oesophageal muscle as well as at the carin a. In all the other cases of IIIB on the CT scanner or MRI scanner whe re the cancer seems to be non resectable, or resectable in a poor clin ical situation, one would envisage surgery only after a re-evaluation secondary to neo-adjuvant therapy.