Neoadjuvant and Adjuvant Trials in Non–Small Cell Lung Cancer

Adjuvant therapy in non–small cell lung cancer has become a controversial topic during this present decade. Postoperative thoracic irradiation has the potential to decrease local recurrence and lessen the probability of postobstructive pneumonia or atelectasis. However, as a single modality, in several randomized studies, it has failed to have a favorable impact on survival. Most postoperative adjuvant chemotherapy studies, likewise, have not improved survival compared with operation alone. Recently, there has been a resurgence of interest in preoperative (neoadjuvant) chemotherapy in clinical stage IIIA disease, based on two very positive, albeit small, phase III studies. Improved chemotherapy in stage IV disease using newer and more effective agents, such as vinorelbine (Navelbine), paclitaxel (Taxol), or gemcitabine (Gemzar), is now available. It is hoped that the modest gains in stage IV disease can translate to more significant improvement in earlier stage disease.