Preoperative treatment strategies in stage III non-small cell lung cancer

Recent experience has emphasized the need to include systemic chemotherapy in combined-modality management of locally advanced non-small cell lung can cer stage HL If definitive surgery is planned in these situations, preopera tive application of drugs-induction chemotherapy-has many advantages in com parison to postoperative delivery. Patients' compliance to treatment, achie vable dose intensities of drugs, possible locoregional downstaging, and fre quent postoperative problems following complex resections are some of the a rguments favouring preoperative chemotherapy. Despite numerous phase-II inv estigations, little evidence from randomized phase-Ill trials has been gene rated. Early inclusion of radiotherapy prior to definitive resection may he lp to improve preoperative downstaging. Besides available mature phase-II d ata, phase-Ill results from ongoing randomized trials are lacking to define the overall value of such a complex approach. Important issues in the futu re will aim at individualizing these intensive programs according to findin gs in clinical prognostic factor analyses and to prospectively validate a p rognostic risk stratification. Data from translational and molecular resear ch may further help to develop such evidence-based guidelines. (C) 2001 Els evier Science Ireland Ltd. All rights reserved.