Multimodality treatment of resectable non small-cell lung cancer

In early-stage, resectable non small-cell lung cancer other than stage IA, survival following surgical resection has been disappointing. Many phase III adjuvant trials using postoperative chemotherapy, radiotherapy, or chemoradiation have had disappointing results results that have been confirmed by two recent meta-analyses. Preoperative radiotherapy combined with surgery has also failed to improve survival following surgical resection. For the past 20 years, several phase II trials have investigated the use of induction therapies (chemotherapy or chemoradiation) prior to surgery in the management of stage IIIA lung cancer. The phase II trials have been encouraging, and two small phase III trials have confirmed the efficacy of the multimodality approach. Newer, more tolerable chemotherapeutic agents are now being investigated. Because of the encouraging results in locally advanced disease, this induction therapy has been used in two trials of early stage (IB, II) disease; both trials have suggested that induction therapy improved patient tolerance to chemotherapy and in one trial perhaps improved survival. Currently, several phase III trials are attempting to confirm these early encouraging reports.