Induction chemotherapy or chemoradiotherapy before surgery for non-small-cell lung cancer

Two controversies regarding the role of induction therapy before surgery in non-small-cell lung cancer are considered through a review of the literature and ongoing trials worldwide. The first debate asks whether surgery is indicated after induction chemotherapy or chemoradiotherapy for patients with advanced stage III disease. The second debate addresses disease presentations with early stage disease or radiographically negative but microscopically positive N2 involvement. The question raised for this group of patients is whether induction chemotherapy with or without radiotherapy should be routinely prescribed before the standard therapy of definitive surgery. For both controversies, data are provocative and in some subsets argue in favor of the more aggressive approach. However, changes in standard-of-care recommendations are premature. Thus, ongoing worldwide trials maintain control arms of chemoradiotherapy alone and of surgery alone in the advanced and early disease subsets, respectively.