The role of induction therapy and surgery for stage IIIA lung cancer

In stage IIIA lung cancer, the role of induction chemotherapy or chemoradiotherapy prior to surgical resection has been studied extensively in patients identified preoperatively as having N2 disease. Both types of induction treatment have resulted in significant response and resection rates. Three trials have randomized patients to this form of treatment versus primary surgery. In all three trials the combined modality therapy has been significantly more effective, resulting in longer median survival times and estimated five year survival times. This new-found optimism for combined modality therapy including surgery is presently being compared to more standard therapy - chemoradiation for patients suffering from this stage of disease. In the future, this type of treatment will be investigated in earlier stage disease, classically treated by surgery, but often yielding less than satisfactory five year cancer free survival times.