AN HISTORICAL-PERSPECTIVE OF MULTIMODALITY TREATMENT FOR RESECTABLE NONSMALL CELL LUNG-CANCER

We examine the origins of surgical therapy, radiotherapy, and chemothe rapy as they were applied to lung cancer in the mid-portion of this ce ntury. Surgical therapy for lung cancer started in the 1930s with pneu monectomies. The prognostic significance of nodal metastases was soon recognized, and surgical staging procedures became an important part o f patient workup, Radical radiotherapy for potential cure of lung canc er began in the 1950s with megavoltage linear accelerators, The first application of chemotherapy for lung cancer was the use of nitrogen mu stards in the 1940s. Single modality surgical therapy has become the t reatment of choice for Stages I and II non-small cell lung cancer, but 50% of clinical Stage I patients die of recurrent disease, and 70% of those recur outside the chest. Biologic markers may identify high ris k subgroups of Stage I and II patients who may benefit from adjuvant c hemo- or radiotherapy, Within the last decade, several single and mult i-institutional Phase II trials and two single institution Phase III t rials have reported improved survival in Stage IIIA patients treated w ith cisplatin-based neoadjuvant chemotherapy prior to surgical resecti on, These trials have reported high response and resectability rates, but at a substantial toxicity, A new standard of care for Stage IIIA d isease has not been conclusively established.