*3.3. Salvage Surgery after Combination Therapy with CRT and Immunotherapy*

In the phase III PACIFIC study, eligible patients received durvalumab after CRT, and this combination therapy significantly prolonged progression-free survival (PFS) compared with that in the placebo group (16.8 months versus 5.6 months) [23].

Regarding the addition of surgery to this combination therapy, the significance of surgical intervention after CRT followed by ICI remains unclear. Recently, a clinical trial (JCOG1807C) was initiated to clarify the safety and efficacy of multimodality treatment of pre- and postoperative durvalumab therapy after preoperative CRT for resectable superior sulcus tumor (SST) and durvalumab maintenance therapy after CRT for unresectable SST. In this study, eligible patients were assigned to two groups: concurrent CRT (cisplatin+S-1+radiotherapy 66 Gy) + two courses of durvalumab followed by surgery and adjuvant durvalumab for resectable SST and CRT followed by maintenance durvalumab for unresectable SST. The primary end-point is 3-year OS. We await the results of this trial.
