Neoadjuvant treatment in locally advanced non-small cell lung cancer

Any neoadjuvant or preoperative treatment program that would increase survival in clinically advanced non-small cell lung cancer (NSCLC) patients would be of significant benefit. In addition to improving patient survival, the program should be associated with minimal toxicity and surgical mortality. The rationale for any preoperative program is that the ability to resect the advanced cancer will be enhanced and micrometastasis will be eradicated. We have analyzed 323 patients enrolled in various types of neoadjuvant and preoperative studies. Review of this data indicates that cisplatin containing regimens produce relatively high responder rates in locally advanced NSCLC patients, resectability rate can be increased by a neoadjuvant program and chemotherapeutic toxicity and operative mortality are not prohibitive. Survival data frequently includes T3N0-1 patients, but there does appear to be increased survival at 3 and 4 years. These studies remain experimental and continued analysis is necessary before they can be accepted as standard therapy for clinically advanced NSCLC cancer.