[Adjuvant chemotherapy in the treatment of non-small cell lung cancer]

For its high incidence and lethality lung cancer represents one of the most serious medical and social problems. Even the early stages of non-small cell lung carcinomas (NSCLC) in comparison with tumours of other location have comparatively unfavourable prognosis, even if the patient undergoes radical surgical treatment. Most of patients die from remote metastases. Most probably it is due to the presence of clinically undetectable micro-metastases developing already in the time of surgery, which progress when the primary tumor was removed. Endeavour to improve results of surgical treatment in early stages of NSCLC disease is aimed at neoadjuvant preoperative and adjuvant postoperative chemotherapy. Present recommendations concerning the adjuvant NSCLC chemotherapy result from recent studies. Prognosis of patients in NSCLC stage IA is comparatively favourable and no evidence has been presented that adjuvant chemotherapy improves survival. Adjuvant chemotherapy is therefore indicated after the radical surgery of NSCLC stage IB-II. Adjuvant chemotherapy should include combination of paclitaxel, docetaxel, vinorelbine or gemcitabin with platin derivates. Patients in good clinical conditions should receive four cycles of chemotherapy in three weeks intervals. Treatment should start at latest 6 weeks after the surgery. Maximal effort to administer the planned dose of chemotherapy in the planned schedule should be given. The role of adjuvant chemotherapy in NSCLC patients of stage IIIA remains indeterminate. The most rational approach to those patients is the neoadjuvant chemotherapy or chemoradiotherapy with subsequent surgical treatment.