Neoadjuvant chemoradiation in non-small cell lung cancer

Combined surgery and radiotherapy has become a standard treatment regimen for patients with multiple cancers. For non-small cell lung cancer, however, this strategy is currently used only in clinical trial settings because of its high metastatic potential, which reduces the effectiveness of local and systemic treatments. Recent results from phase III studies comparing surgery and radiotherapy in stage IIIAN2 locally advanced non-small cell lung cancer after induction treatment showed that surgery should only be performed in patients presenting with a major mediastinal downstaging and the possibility of curative resection by lobectomy. In all other cases, exclusive chemoradiation remains the therapeutic standard at this time. These developments make treatment of locally advanced non-small cell lung cancer a model for multimodal strategies in oncology, combining chemotherapy, radiotherapy and surgery.