Neoadjuvant chemotherapy in early-stage non-small cell lung cancer

Surgical resection followed by adjuvant chemotherapy is the standard of care for completely resected stages II and III non-small cell lung cancer (NSCLC) patients. In order to improve survival in patients with early-stage NSCLC, efforts have been focused on the use of chemotherapy and radiotherapy before surgery with the aim of reducing the risk of relapse. Neoadjuvant chemotherapy is an attractive treatment option which is employed in different tumors and may well be associated with certain advantages in NSCLC patients such as being effective in treating occult microscopic systemic disease, downstaging mediastinal lymph node and improving the success of surgery by tumor reduction. Furthermore, chemotherapy compliance prior to surgery is generally better than after surgery. The potential disadvantages are treatment-related toxicities and the delay of surgery. At present, neoadjuvant chemotherapy is still considered an experimental treatment modality in early-stage disease and its role should be more clearly defined.