Induction therapy followed by definitive local control for stage III non-small-cell lung cancer. A review, with a focus on recent trimodality trials.

Abstract

This review first summarizes the potential survival outcomes for patients with the various subsets of stage III non-small-cell lung cancer. The rationale for combined-modality approaches is then reviewed, with a discussion of the possible treatment strategies using various permutations of three treatment modalities, namely, chemotherapy (CTh) radiotherapy (RT), and surgery. Conclusions that can be drawn from the published bimodality trials are discussed. The design, eligibility criteria, surgical findings, and survival data for five trimodality phase II studies of CTh plus RT followed by surgery are then presented in detail (with a focus on three larger trials). Finally, the review provides a consideration of toxicity, other caveats, and possible conclusions that can be drawn at this point from the phase II bimodality and trimodality studies involving surgery. Important questions for future study are outlined.