Role of chemotherapy in stages I to III non-small cell lung cancer

The management of resectable non-small cell lung cancer (NSCLC) has been th e focus of extensive investigation over the last decade. Nonetheless, exist ing management strategies are suboptimal for all stage groupings. The only exception is complete resection for stage IA NSCLC, in which a cure is achi eved in 70 to 85% of patients. A number of studies demonstrate that adjuvan t chemotherapy may be associated with some biological effect. Nonetheless, chemotherapy remains experimental and cannot be definitively recommended ou tside the contest of a randomized trial. Radiation therapy appears to be as sociated with a reduction in local recurrence in stage II NSCLC, With regar d to potentially resectable stage IIIA NSCLC, the results of randomized tri als support the conclusion that induction chemotherapy followed by resectio n (with or without postoperative radiation) may enhance survival compared t o that achieved with resection alone. Among patients with stage IIIA and II IB NSCLC who are treated without resection, numerous phase III studies demo nstrate that induction chemotherapy with definitive radiation improves outc ome when compared to thoracic radiation therapy alone. While there may be a n advantage for concurrent chemoradiation compared to sequential therapy, d efinitive results are not yet available to support this conclusion. While t he magnitude of benefit associated with induction chemotherapy or chemoradi ation in regionally advanced NSCLC is debatable, the results of multimodali ty studies provide a basis for optimism that real therapeutic progress is b eing achieved, Further study of therapeutic strategics that incorporate agg ressive systemic treatment and local-regional therapy in stage IIIA and III B NSCLC is warranted. Moreover, completion of randomized studies focusing o n the role of adjuvant chemotherapy in stage IB and stage II NSCLC should b e given priority.