Clinical challenge in pulmonary squamous cell carcinoma: crucial decisions in neoadjuvant management

Introduction: Neoadjuvant treatment in locally advanced non-small cell lung cancer has gained relevance following the introduction of immunotherapy. Complete metabolic response (CMR) in recent studies has been associated with favorable prognosis. Case report: A 64-year-old heavy smoker with COPD presented with progressive dyspnea, dysphonia, and weight loss. Diagnosed with left squamous cell lung carcinoma, stage IIIA (T4N0M0), with recurrent nerve involvement. PET and EBUS confirmed no nodal disease. Neoadjuvant carboplatin, paclitaxel, and pembrolizumab led to a CMR on PET. Surgery was proposed (left pneumonectomy) but declined by the patient due to functional risk. Immunotherapy was continued. The patient remains clinically stable with sustained CMR. Conclusion: This case highlights the efficacy of neoadjuvant chemoimmunotherapy in selected patients with locally advanced NSCLC. Individualized decisions in the context of CMR and high surgical morbidity represent an important clinical challenge.