Preoperative and adjuvant chemotherapy in non-small cell lung cancer

In non-small cell lung cancer (NSCLC), if the tumor is completely resected in stage I, II, and IIIa disease, the outlook is favorable. In stage IIIa disease, preoperative chemotherapy is efficacious and also confers the potential for improved resectability rates and survival. In a study of 58 patients with locally advanced (stage IIIa) NSCLC, preoperative combination chemotherapy with mitomycin C, cisplatin, and vinca alkaloids yielded 7 complete responses and 37 partial responses. Of the 44 patients with major responses, 42 were surgically explored and 33 were completely resected. Nine patients had pathologically negative biopsy specimens. The median survival for all patients thus far is 19.5 months. These results indicate that surgery can be performed safely in patients treated preoperatively with currently available chemotherapeutic agents. Moreover, complete resections are feasible and can be accomplished in a majority of patients.