[Combined multimodality treatment for non-small cell lung cancer--with special reference to pre- and post-operative adjuvant therapy]

Abstract

Surgical resection is the treatment of choice for patients with localized non-small cell lung cancer. However, the long-term survival rate of patients after such surgery is disappointing. Even in stage I patients who have undergone potentially curative operation, over 30% of them recur within five years. Most of the recurrences are caused by hematogenous metastases to the distant organs. However, all of the comparative study to evaluate postoperative adjuvant therapy, ie, chemotherapy, immunotherapy, radiotherapy, or their combination, showed negative results, except for a few positive outcomes. To date, there is no evidence that pre- and postoperative adjuvant therapy have shown a favorable impact on survival of postoperative patients with stage I disease. LCSG has had reportedly favorable results on survival of stage II and III adenocarcinoma and large cell carcinoma by postoperative CAP-chemotherapy. Postoperative chemotherapy and/or radiotherapy showed no impact on survival of stage III patients who underwent surgical intervention. However, preoperative induction therapy (IT) using combination chemotherapy (with or without radiotherapy) has improved the survival of patients with resected stage III disease, although most reports are of phase II trial or interim results. It seems to be true that the IT can render an advanced lung cancer resectable and also can control pre-existing micro-metastases in the distant organs. However, randomized prospective trials are required for evaluating an impact on the survival rate of the advanced non-small cell lung cancer.