Multimodality therapy in the treatment of lung cancer

Lung cancer is the leading cause of cancer death in the world, causing more than one million deaths each year. The incidence and mortality rates are highest in the United States and Europe and continue to increase in developing nations. Non-small cell lung cancer (NSCLC) accounts for 80 to 85% of all new cases of lung cancer. The majority of patients with NSCLC present with advanced disease at the time of diagnosis. Although the prognosis of advanced NSCLC is very poor, current chemotherapy combinations have been shown to improve 1-year survival and quality of life for these patients. Approximately one third of patients with NSCLC are diagnosed with locally advanced disease. Although cure rates are modest and variable in locally advanced NSCLC, multimodality therapy (chemotherapy in combination with surgery or radiotherapy) has resulted in statistically significant improvement in 5-year survival when compared with surgery or radiotherapy alone. Patients with early-stage NSCLC have the best long-term survival rates following surgical resection; however, systemic recurrences remain a problem in the majority of these patients. The rationale for treating patients with early-stage NSCLC with combined-modality therapy (chemotherapy and surgery) is compelling, and several randomized trials are currently in progress. Although progress has been slow, when we consider the recent advances in smoking prevention, smoking cessation, staging classification, imaging and diagnostic techniques, screening and therapeutic modalities, and multidisciplinary care, as well as in the understanding of the molecular pathogenesis of lung cancer, the future, in my opinion, is very promising.