Multimodality therapy for stage IIIA (N2) lung cancer. An overview

Disappointing results of surgery and postoperative adjuvant chemotherapy or chemoradiotherapy in stage IIIA (N2) lung cancer have led to a number of phase II trials of induction (neoadjuvant) chemotherapy given prior to surgery. Preliminary results of 2 such studies indicate that mitomycin, vinca alkaloid, and platinum (MVP) given before surgical excision induces an overall response rate of 70% (9 complete responses and 71 partial responses in 112 patients). Of 80 patients who ultimately underwent surgery, complete resection was achieved in 62 (55%). Survival data reflect a median survival of 19.5 months for the entire cohort of 112 patients and 27 months for those who had complete resection. The 5-year-survival rate is expected to reach 15%. Randomized trials are now under way to establish whether this aggressive approach to therapy represents the most appropriate form of treatment for patients with stage IIIA (N2) lung cancer.