Mediastinal lung cancer: answers and questions

A literature review was done to define the relative roles of radiation and surgery in the treatment of mediastinal stage III, non-small-cell lung cancer with no distant metastasis. No two reports are comparable. Little information is available on the clinical, preoperative stage as it relates to surgical findings and to survival. Rationale for adjuvant radiation is lacking from the reports. There is no survival advantage of surgery, even with postoperative radiation, over radiation alone for clinical stage III disease. Patients whose cancer seems early stage but is found to be pathologic stage III at time of surgery may benefit from the combination therapy, although this is controversial. Treatment failure is usually systemic, so there is a strong argument for adjuvant chemotherapy as well. Uniform multimodality reporting of results is necessary so that the appropriate roles of surgery, radiation, and chemotherapy can be identified for this group of patients.