Benefits of neoadjuvant chemotherapy in NSCLC

There is a significant potential benefit for induction chemotherapy in the management of non-small cell lung cancer (NSCLC). The real extent of such benefit is difficult to assess on the basis of available data owing to the intrinsic limitations of phase II studies. In fact, in most studies on neoadjuvant chemotherapy, the aim of the treatment (local control vs systemic effect) is often unclear, the eligibility criteria poorly defined, and pretreatment staging inadequate. Consequently, the interpretation of the results of such studies has proved difficult. This article examines the critical role of thoracic surgeons in the selection, staging, and optimal treatment of patients enrolled in neoadjuvant studies, and also in monitoring the quality of data and providing adequate specimens for concurrent biologic research. Within the framework of controlled trials, with proper methods and minimum toxic reactions, induction chemotherapy may be offered in the future to a large number of patients and eventually combined with long-term adjuvant/chemopreventive strategies.