Multimodality curative-intent treatment in NSCLC: an unprecedented era of change 2017-2025.

Since 2017, the systemic therapy backbones with multimodality treatment have undergone a dramatic transformation, driven by a series of pivotal, practice-changing clinical trials.

自2017年以来，多模式治疗的全身治疗基础经历了一场戏剧性的转变，这一转变是由一系列关键的、改变实践的临床试验推动的。

Immunotherapy and targeted therapies, previously confined to the advanced/metastatic setting, are now firmly embedded in curative-intent regimens.

免疫治疗和靶向治疗，之前仅限于晚期/转移性疾病的治疗，现在已牢固地嵌入到旨在治愈的治疗方案中。

Maintenance immunotherapy following chemoradiation in unresectable stage III disease, adjuvant tyrosine kinase inhibitors in resected epidermal growth factor receptor/anaplastic lymphoma kinase-positive tumours, neoadjuvant and perioperative chemoimmunotherapy in resectable stage II/III NSCLC and adjuvant chemoimmunotherapy following resection have all become new standards of care.This state-of-the-art review synthesises the key evidence underpinning these developments, highlights their clinical implications and identifies challenges to implementation-particularly the need for redefined clinical pathways, accurate pretreatment staging, timely biomarker testing and coordinated multidisciplinary decision-making.

在不可切除的III期疾病中，化疗和放疗后的维持免疫治疗，切除的表皮生长因子受体/间变性淋巴瘤激酶阳性肿瘤的辅助酪氨酸激酶抑制剂，可切除的II/III期非小细胞肺癌的新辅助和围手术期化疗免疫治疗，以及切除后的辅助化疗免疫治疗，都已成为新的护理标准。这项最新的综述综合了这些发展的关键证据，强调了它们的临床意义，并确定了实施的挑战——特别是需要重新定义的临床路径、准确的治疗前分期、及时的生物标志物检测和协调的多学科决策。

A novel treatment algorithm is proposed to support clinicians in navigating these complex treatment choices.We conclude that immunotherapy and targeted agents have irrevocably altered curative-intent NSCLC care, establishing multiple new standards that sometimes overlap and compete.

我们提出了一种新的治疗算法，以帮助临床医生在这些复杂的治疗选择中导航。我们得出结论，免疫治疗和靶向药物已经不可逆转地改变了具有治愈意图的非小细胞肺癌（NSCLC）的护理，建立了多个有时重叠和竞争的新标准。

In the surgical multimodality treatment pathway, neoadjuvant and perioperative chemoimmunotherapy offers the opportunity to increase the uptake of systemic therapy in comparison to adjuvant therapy and is considered by these authors to represent the optimal treatment path for most patients.In this unprecedented era of therapeutic expansion, the greatest challenge is no longer the absence of effective treatments, but the complexity of selecting, sequencing and delivering them, as well as patient optimisation.

在手术多模式治疗途径中，新辅助和围手术期化疗免疫治疗提供了增加全身治疗吸收的机会，与辅助治疗相比，这些作者认为它代表了大多数患者的最佳治疗路径。在这个前所未有的治疗扩展时代，最大的挑战不再是缺乏有效治疗，而是选择、排序和交付它们的复杂性，以及患者的优化。

Lung cancer services must evolve through proactive pathway redesign, integrated diagnostics and new models of multidisciplinary care.

肺癌服务必须通过积极的路径重建、集成诊断和新的多学科护理模式来发展。

High-quality, biomarker-driven and patient-centred care is now achievable for many patients with stage II-III NSCLC-but it will require system-level adaptation to deliver it.

对于许多II-III期非小细胞肺癌患者来说，高质量的、生物标志物驱动的和以患者为中心的护理现在是可实现的——但这将需要系统级的适应来提供。