Inductive and adjuvant treatment strategies for localized nonsmall cell lung cancer in operable and inoperable patients.
For many years, surgery has been considered the best treatment modality for resectable nonsmall cell lung cancer. However, survival has not increased over the last few decades. The reported 5-year survival rates for the early stages (stage I and II) show failures of 35 to 65%. Therefore, a combined modality approach has been taken in patients with N2 (lymph node) disease to improve results. These adjuvant treatments, consisting of chemotherapy, radiotherapy, or both, have yielded mixed responses. Adjuvant radiation therapy alone has shown a decrease in local recurrence but no significant improvement in survival. Randomized trials of adjuvant chemotherapy have shown mixed results, and large, randomized trials are currently being evaluated. Combinations of radiation and chemotherapy in the adjuvant setting have failed to show a survival benefit so far. In the neoadjuvant setting, chemotherapy has aroused great attention because it has significantly improved survival in patients with locally advanced nonsmall cell lung cancer (N2 disease). This result led to the use of neoadjuvant chemotherapy in early-stage lung cancer. Multinational and multi-institutional studies have been initiated recently. In the future, researchers will have clear insight into the effects of the classical chemotherapy regimen as induction therapy in the early stages of nonsmall cell lung cancer. Tyrosine kinase inhibitors, antisense therapies, and antiangiogenesis therapies are the most promising developments of the last few years. Implementation of these agents is expected to have great impact on the survival in patients with nonsmall cell lung cancer.
Baas
Paul
P
Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. p.baas@nki.nl
D002289:Carcinoma, Non-Small-Cell Lung / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*