Preoperative chemotherapy in early-stage (stage IB-IIIA) resectable non small cell lung cancer. Is it justified?

Only 20-30% of patients with non small cell lung cancer (NSCLC) present with early-stage disease at the time of diagnosis and may benefit by surgical resection. Five-year survival in early-stage disease varies from 38 to 57% for stage IB and from 13 to 23% for stage IIIA according to the clinical and pathological assessment of the patients. Occult micrometastatic disease already present in many patients with resectable NSCLC at the time of diagnosis and surgical treatment leads to local and distant disease recurrence. Therefore a more systemic approach should be considered in early-stage disease. The role of adjuvant chemotherapy has already been established in this field. Within the past decade attention has been focused on the possible beneficial effects of preoperative chemotherapy considering that patients' compliance to the induction treatment can be very high with eventual eradication of micrometastatic disease and primary tumor downstaging. In this review we present the currently available data on induction chemotherapy followed by surgery in early-stage (stages IB-IIIA) NSCLC with a fundamental question to be answered: is this approach justified in current clinical practice?