NEOADJUVANT CHEMOTHERAPY OF LOCALLY ADVANCED NONSMALL CELL LUNG-CANCER

Neoadjuvant chemotherapy was tested in non-small cell lung cancer in a n attempt to increase the resectability of the tumor and to treat the microscopic metastatic disease known to be responsible for the majorit y of failures in surgically treated patients. This review deals with p ublished trials. Most of them are feasibility studies in Stage III NSC LC. Obviously, the heterogeneity of eligibility criteria from one stud y to another prevents general conclusions on the usefulness of neoadju vant chemotherapy. However, it is possible to conclude that neoadjuvan t chemotherapy has an antitumor activity: the majority of the studies report a 60% objective response rate including a significant number of complete responses and a 50% complete resection rate. Neoadjuvant che motherapy does not increase morbidity after surgery except when it is combined with preoperative radiation therapy. At the time of writing, one Phase III randomized study comparing neoadjuvant chemotherapy foll owed by surgery with surgery alone has been published. This study conc ludes that the combined modality treatment improves the survival of pa tients with locally advanced non-small cell lung cancer. Taken as a wh ole, the literature deserves further studies to determine the place of neoadjuvant chemotherapy in lung cancer.