Chemotherapy and radiotherapy in the treatment of resectable non-small-cell lung cancer

Surgical resection remains the cornerstone of therapy for early-stage disease and offers the best chance for cure. Local and distant failure rates, however, remain unacceptably high with surgery alone. Radiation and systemic chemotherapy have been used to reduce recurrences in early-stage disease. Neoadjuvant and adjuvant strategies both offer sound theoretical benefit, but evidence supporting this has been lacking. The publication of a meta-analysis in 1995 triggered a reevaluation of adjuvant chemotherapy. Four randomized trials reported in the last 2 years support the use of adjuvant platinum-based chemotherapy. This article reviews the history of clinical trials evaluating neoadjuvant and adjuvant therapy in non-small-cell lung cancer. Adjuvant chemotherapy improves 5-year survival rates by approximately 5%-15% compared with surgery alone. Surgical resection followed by adjuvant chemotherapy is the standard of care treatment for patients with completely resected stage I, II, and IIIA non-small-cell lung cancer.