New adjuvant strategies for the management of resectable non-small-cell lung cancer.

Abstract

Continued development of adjuvant therapy strategies is required to improve chances of long-term survival in patients with resected non-small-cell lung cancer (NSCLC). Distant micrometastases comprise the bulk of failures in patients with resected stage I disease, although the risk of local failure increases in patients with stage II or IIIA disease, distant metastasis remains a critical problem. Optimum adjuvant treatment may require both radiotherapy and chemotherapy. Adjuvant radiotherapy has been shown to eliminate first failure in local sites in patients whose stage II or IIIA squamous cell carcinoma has been fully resected, without producing an overall improvement in survival. Adjuvant combination chemotherapy can delay time to recurrence significantly and improve failure-free survival, although once again, no statistically significant prolongation of survival has been observed. One trial combining sequential chemotherapy and radiotherapy reported a significant reduction in the incidence of distant metastases compared to treatment with radiation alone in patients with unresected stage III disease. Current and planned American trials have varied the timing, dose intensity, and scheduling of chemotherapy as well as the control arm employed. It is hoped that the results will demonstrate unequivocal benefit for adjuvant therapy in the management of patients with operable NSCLC.