Preoperative chemotherapy for stage IIIa non-small cell lung cancer

About 20% of patients with non-small cell lung cancer are stage IIIa at diagnosis. The treatment of stage IIIa tumors has been discouraging. Long-term disease control and cure rates with a single modality approach with surgery or radiotherapy have been poor; this is particularly so for N2 tumors, which account for the majority of stage IIIa disease. In the past decade there has been interest in multimodality treatment of stage IIIa non-small cell lung cancer using preoperative induction chemotherapy with or without radiotherapy followed by surgery. Several phase II studies and two small phase III trials have shown that a strategy of induction chemotherapy with or without radiotherapy is feasible and probably does offer some survival advantage over surgery or radiotherapy alone. The next issue to be tackled is to determine whether the results achieved with induction chemoradiation followed by surgery are equivalent to those of chemoradiation without surgery. A phase III intergroup trial is underway to answer this question.