[The role of neoadjuvant therapy in the treatment of locally advanced, stage III non-small-cell lung cancer].
OBJECTIVE
to review the progress achieved in the neoadjuvant treatment of patients with locally advanced NSCLC by evaluating the articles published during the last 10 years.


METHODS
altogether 51 articles (including prospective and retrospective studies, and reviews) were analysed with the intention to evaluate the efficacy of the different neoadjuvant modalities.


RESULTS
different types of neoadjuvant treatments were reported. The articles were heterogeneous not only in the aspect of the patient populations but also in regard to the treatment modalities and schedules, the mode and timing of combination of chemotherapy with radiotherapy. Most studies support the advantage of chemoradiotherapy. The chemotherapy should be platinum based, and combination with modern drugs as gemcitabine is recommended. Surgery provides the best local control of the disease. Lobectomy, and in special circumstances sleeve resection, are preferred. The best prognostic factors are the R0 resection and the downstaging of the mediastinal lymph nodes. The cause of death is usually progressive disease, often brain metastases. Because of frequent occurrence of brain metastases, preventive cranial irradiation is recommended by many authors.


CONCLUSIONS
to be able to compare different treatment modalities with consistent patient groups, patients should be classified into well-defined subgroups. T4 tumours (except pleuritis carcinomatosa) behave as locoregional disease, N2/N3 tumours, however, resemble more to systemic diseases. With two- or three-modality treatment, 3-7% improvement can be achieved in the 5-year survival time of patients. Evaluating the results, the heterogeneity of stage III NSCLC should always be kept in mind. It is still unknown to which patients should surgery be offered after neoadjuvant therapy, and who will benefit more from chemoradiotherapy alone. Considering the downstaging effect of the therapy, the tumour and nodal state should be evaluated separately. To answer these questions, it is time to start large randomised studies.
Balikó
Zoltán
Z
Tüdôgyógyászat, Baranya Megyei Kórház, Pécs 7635, Hungary. bmktudo@enternet.hu
Sárosi
Veronika
V
D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome