PRESENT STATUS OF INDUCTION TREATMENT IN STAGE IIIA-N2 NONSMALL CELL LUNG-CANCER - A REVIEW

Background: Surgical exploration in mediastinoscopy proven N2 non-smal l cell lung cancer (NSCLC) is unrewarding. Theoretical concepts sugges t a beneficial role for preoperative induction treatment. The solidity of the therapeutic results with this approach in the currently availa ble data is examined. Methods: Literature on induction therapy followe d by surgical exploration, consisting of randomized reports and phase II reports meeting some essential criteria, are reviewed. Results: Of the twenty-four analyzed phase II studies, thirteen lack adequate surg ical staging. Stratification for various important prognostic factors in N2 disease is missing in many instances. Results with induction wit h a cisplatinum dose of less than 80 mg/m(2) seem to be inferior. The use of mitomycin-C in patients scheduled for lung resection or irradia tion deserves caution. No evident difference in efficacy between induc tion chemotherapy or chemo-radiotherapy is suggested, but toxicity and mortality appear to be somewhat higher with chemo-radiotherapy. Patho logical complete response is mainly found after an at least partial cl inical response. Effect on survival in non-controlled phase II studies and small randomized reports is encouraging. Conclusions: the role of chemotherapy induction in improving the long-term survival of N2 NSCL C is promising, but needs to be confirmed by large multi-center random ized data. Adequate surgical staging and attention to important progno stic factors in N2 disease should minimize the numerous institution ba sed differences interfering in the currently available non-controlled studies. (C) 1998 Elsevier Science B.V.