[Multimodality treatment for non-small cell lung cancer from the surgical standpoint]

Mediastinal lymph node metastasis is the most important issue in surgical treatment for non-small cell lung cancer. Systematic lymphadenectomy made its stage accurate. Its significance for prognosis is not clear. Adjuvant radiotherapy reduced local recurrence, but could not improve the prognosis. Adjuvant chemotherapy only sometimes improves it the survival. A meta-analysis reported that adjuvant chemotherapy for completely resected patients could lead to a 5% improvement in 5-year survival. Induction chemotherapy for N2 disease should assure good results compared to historical control. A randomized control study of induction chemotherapy vs. surgery alone revealed that this modality is worthwhile, but no lonsensus was obtained. Concurrent chemoradiotherapy could bring about a down stage that leads to a better prognosis, and is a promising strategy.