Adjuvant and induction chemotherapy in non-small cell lung cancer

About 25%-30% of patients with non-small cell lung cancer can be resected w ith curative intent. However, systemic relapses occur in up to 70% of these patients. Thus, postoperative adjuvant chemotherapy was evaluated in sever al randomised trials but the results of these trials were inconclusive with a survival benefit only in some trials. Shortcomings of these trials inclu ded low number of patients, poor patient compliance and inadequate chemothe rapy protocols. A recent meta-analysis suggested an absolute survival benef it of 5% at five years for postoperative cisplatin-based chemotherapy as co mpared to surgery alone. Thus adjuvant chemotherapy with both improved chem otherapy protocols and improved anti-emetics is currently re-evaluated in s everal randomised trials on large patient populations. Patients with locally advanced (stage III) non-small cell lung cancer requi re a multimodal approach with both local therapies (surgery, radiotherapy o r both) and systemic chemotherapy. Patients with completely resected stage IIIA disease should be enrolled in randomised adjuvant chemotherapy trials with or without radiotherapy. Patients with clinically stage IIIA and selec ted patients with stage IIIB are candidates for induction chemotherapy foll owed by surgery. The remaining stage III patients should receive combined c hemoradiotherapy.