Does adjuvant chemotherapy decrease distant metastasis formation in patients with non-small cell lung cancer?

Disseminated micrometastatic disease limits the effectiveness of even the most aggressive locoregional treatment strategies in patients with early stage non-small cell lung cancer. One trial of the Lung Cancer Study Group (LCSG) demonstrated a significant decrease in the hazard rate for distant recurrence produced by adjuvant CAP chemotherapy after surgical resection and radiation therapy. French investigators found a significant decrease in distant metastases formation following sequential chemotherapy, radiation, and then additional chemotherapy compared to radiation alone in patients with stage III disease. However, other completed trials are either inconclusive, incompletely analyzed thus far or show no evidence of an effect of adjuvant chemotherapy on distant metastases. Additional data from recently completed or current trials will hopefully clarify the impact of adjuvant chemotherapy on distant micrometastases in patients with potentially curable non-small cell lung cancer (NSCLC).