New approach to postoperative adjuvant treatment in non-small-cell lung cancer

Abstract

Depending on the pathological stage at presentation, 40-75% of non-small-cell lung cancer patients die within 5 years despite complete resection alone. The majority of them experience distant relapse. Postoperative radiotherapy may decrease the rate of local relapse in patients with pN2 disease, but has a detrimental effect on survival in stage pI and pII patients. The value of postoperative adjuvant chemotherapy has been a matter of discussion for many years. Three randomised trials published in recent years together with two large meta-analyses provided evidence in favour of adjuvant chemotherapy with an absolute benefit of 4-15% in 5 years. Survival benefit was found mainly in stage pII and pIIIA patients. At present, postoperative chemotherapy may be regarded as standard approach in these patients provided they represent good performance status. The major issue now is to identify subsets of patients who could tolerate chemotherapy better and have greater benefit from adjuvant chemotherapy. Both aims could be achieved in future by genetic and molecular-based selection.