Neoadjuvant approach for nonsmall cell lung cancer: overview of the current issues

Despite the large numbers of studies, role of neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy is debated. This approach would increase resectability in locally advanced patients, and improve surgical outcome in resectable patients. Thus, an overview of recent literature is relevant to highlight the current issues.

Literature in the previous year mainly focused on overall treatment strategy, radiotherapy technique, role of radiological response and metabolic imaging, and biological agents in this setting.

Current data suggest that neoadjuvant chemotherapy is beneficial if compared with surgery alone or definitive chemoradiotherapy. Benefit of radiotherapy addition in this setting is not clear, especially in patients undergoing pneumonectomy. Hypofractionated regimens and dose escalation protocols should be considered for further investigation. Response evaluation with radiologic and metabolic assessment is prognostic for survival outcome; its usefulness as a selection tool for adaptive strategies has been investigated recently. More robust data on biological agents and immunological agents in this setting are needed; further investigation on predictive biomarker is suggested.