ADJUVANT AND NEOADJUVANT CHEMOTHERAPY IN NON-SMALL-CELL CARCINOMA

Background: There have been many trials investigating the influence of chemotherapy on survival following surgery or radiotherapy in non-sma ll cell lung cancer. Few have been large enough to detect the sort of differences likely to emerge, given the limited efficacy of chemothera py The technique of meta-analysis using individual patient data can al low worthwhile conclusions to be derived from the contradictory data g enerated by multiple small trials. This paper summarizes published dat a from randomized trials testing: (1) adjuvant chemotherapy following 'curative' surgery; (2) neoadjuvant chemotherapy prior to surgery in c ases of borderline operability; (3) chemotherapy in inoperable, but st ill localized, disease where standard therapy would be radical radioth erapy. Conclusion: All the indications are that combinations including cisplatin confer a small, but real, prolongation of survival. However , meta-analysis is not a substitute for individual trials large enough to detect clinically important differences in survival. Other worthwh ile endpoints like symptom control, quality of life and cost cannot be addressed in a meta-analysis. Large, well designed and executed rando mized trials are still urgently needed if more time and money is not g oing to be wasted in the search for better treatments in lung cancer.