Lung cancer staging and treatment in multidisciplinary trials: Cancer and leukemia group B cooperative group approach

Background. Aggressive routine surgical staging is necessary to evaluate pa tients to be treated on cooperative oncology protocols. Less than 1% of lun g cancer patients in the United States are currently being treated in a cli nical trial. Only with results from large, prospective trials can the quest ions of neoadjuvant and adjuvant therapy be answered. Methods. An outline describing the schema of preoperative patient evaluatio n, surgical staging, and the definition of surgical staging and resection p rocedures appropriate for patients considered for cooperative group protoco l is presented. Current Cancer and Leukemia Group B (CALGB) protocols are u sed in the discussion as examples of this systematic approach. Conclusions. Over the next few years, it will be important to enter the max imum number of patients into combined modality studies to identify the role of neoadjuvant treatment in lung cancer. Entry of patients into protocols will also make their pathological specimens and clinical information availa ble for basic science research related to treatment results. Adherence to a logical sequence of patient evaluation as outlined above will optimize pat ient care, as well as accrual to cooperative group studies. (C) 1999 by The Society of Thoracic Surgeons.