Surgery after induction chemoradiotherapy for non small cell lung cancer: when and why

Stages I and II non small cell lung cancer (NSCLC) are primarily treated by anatomic pulmonary resection. Selected patients with stage IIIB disease are still candidates for surgical treatment. Unfortunately most patients with locally advanced NSCLC don't benefit by surgery alone or even by the combination of chemotherapy and radiotherapy. In order to achieve local and distant disease control, which seems to be the cause of failure of the above mentioned treatments, surgery after induction chemoradiotherapy has been proposed. This approach seems to be the state of the art of therapy for these patients improving survival but with eventual increased risks, especially pulmonary and septic complications. This review of previously published studies indicates the important role of this combined treatment in terms of survival and its risks related either to induction treatment or to surgery.