The role of induction therapy in the management of resectable non-small cell lung cancer.
BACKGROUND
Combined-modality therapy has become standard for many patients with non-small cell lung cancer. Although surgical resection offers the best chance for long-term survival, the limited number of resectable patients and the presence of occult micrometastatic disease has limited the effectiveness of this modality alone.


METHODS
The authors reviewed several trials involving the use of induction chemotherapy in managing resectable non-small cell lung cancer.


RESULTS
Extensive phase II experience in patients with stage III disease has confirmed the feasibility of this approach. Unfortunately, heterogeneous patient populations and treatment regimens limit the ability to draw firm conclusions from these trials alone. While the phase III experience has been limited, long-term follow-up is now available suggesting that induction therapy may have a beneficial impact on survival, especially for those patients who can be sufficiently downstaged. Recent phase II trials have included stage III patients who have traditionally been considered inoperable. Although encouraging, the role of surgery after chemoradiotherapy for this population of patients remains undefined.


CONCLUSIONS
Results from ongoing randomized trials studying the impact of induction therapy on well-defined patient populations will be necessary before the optimal regimen and patient population can be identified.
Hensing
T A
TA
Multidisciplinary Thoracic Oncology Program, University of North Carolina, Chapel Hill 27519, USA.
Detterbeck
F
F
Socinski
M A
MA
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome