Role of adjuvant systemic therapy for stage I NSCLC

Based on the limited data presented, in North America and in Europe. one cannot recommend the routine use of adjuvant systemic chemotherapy after the complete resection of stages IA and IB NSCLC. It is possible that the completed trials have been underpowered to see a survival advantage in this patient population that carries a better prognosis overall. The data from Japan are certainly intriguing and bring a potentially new adjuvant strategy for these patients: low-dose, long-term, well-tolerated adjuvant oral therapy. Adjuvant UFT needs to be studied outside of Japan before this strategy gets adopted worldwide. In 2007, in Japan, adjuvant UFT is often recommended after the complete resection of stages IA and IB adenocarcinoma. One also realizes that not every resected stage I tumor carries the same prognosis, a fact that most trials have not taken into consideration. Despite the lack of trial results to support adjuvant chemotherapy in stage IA and IB diseases, however, outside of a clinical trial setting, it is probably reasonable to consider the possibility of adjuvant systemic chemotherapy in the individualized healthy younger patient whose resected tumor exhibited poor prognostic histologic findings, such as lymphovascular invasion, larger size, or even high fluorodeoxyglucose avidity on preoperative positron emission tomography scan. Ideally, however, these patients should all be considered to participate in the next generation of trials exploring the strategy of adjuvant therapy in the management of completely resected stage I NSCLC.