Multimodality Approach for Locally Advanced Lung Cancer: When Is Surgery Most Beneficial?

Background: Stage III non-small cell lung cancer (NSCLC) is a complex and challenging disease due to its variability and the absence of standardized treatment protocols. This study aimed to investigate the role of surgical resection as part of a multimodal treatment approach to improve overall survival (OS) and disease-free survival (DFS) in resource-limited settings. Methods: The medical records of 309 patients who underwent surgery for confirmed primary lung cancer at the King Hussein Cancer Center (KHCC) in Amman, Jordan, between 2016 and 2022 were reviewed. 59 of them diagnosed with Stage III NSCLC underwent curative surgeries. Patients were grouped into three categories: surgery alone, neoadjuvant therapy followed by surgery, and surgery combined with adjuvant therapy. Demographic, clinical, and survival data were statistically analyzed to compare the outcomes across these groups. Results: The study cohort consisted predominantly of males (86.4%), with adenocarcinoma being the most common histological subtype (54.2%). Patients who underwent surgery alone had the lowest recurrence rate and highest three-year OS and DFS rates (66.7%). Improved OS and DFS were observed in patients with pN0 status and no evidence of lymphovascular invasion (LVI). Minimally invasive surgical approaches such as VATS were associated with better perioperative outcomes than open surgery. Conclusion: Surgical resection, particularly when achieving negative margins (R0) in patients with N0 disease, is critical for improving survival in patients with Stage III NSCLC. Multimodal strategies can enhance these benefits further. However, challenges related to healthcare access in resource-limited settings highlight the need for customized treatment protocols and broader access to advanced medical therapies.