Multimodality therapy in surgically resectable early non-small cell lung cancer

Lung cancer is a global epidemic. Unfortunately only a fraction of patients can undergo curative surgery and in these, only one-third survive five years. The remainder die of locoregional and distant metastatic disease. With advances in chemotherapy for systemic control and radiation therapy for local control, responses and survivals have shown promise in extensive inoperable disease. In order to attempt to extend survival in extensive local but operable disease (Stage IIIa), these treatment modalities were added to the surgical regimen either before (neoadjuvant, induction) or after (adjuvant) surgery. Several small phase III trials substantiated the benefits. Since early lung cancer (Stage I and II) recur in 30% of instances to distant sites as well as regionally, multimodality therapies have recently been encouraged in global trials in an attempt to prolong time to recurrence and survival in this latter group of patients. A review follows: