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Vol.42 No.7 contents | Japanese/English |
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The Induction Chemotherapy Followed by Surgery is the Standard Strategy for Clinical III-N2 Non-small Cell lung Cancer
Pro: Masahiro Tsuboi1, Harubumi Kato1The clinical significance of preoperative induction therapy for IIIA (N2) non-small cell lung cancer (NSCLC) was reviewed. In locally advanced NSCLC patients, therapeutic results have remained poor. Five-year survival rate of clinical stage IIIA and pathological one was 34% and 28%, respectively. A number of studies demonstrate that adjuvant chemotherapy may be associated with some biological effect. Nonetheless, chemotherapy and radiotherapy in adjuvant setting remains experimental and cannot be definitively recommended outside the context of a randomized trial. With regard to potentially respectable stage IIIA-N2 NSCLC, the results of randomized trials support the conclusion that induction chemotherapy follwed by surgery (with or without postoperative radiotherapy) may enhance survival compared to that achieved with surgical resection alone. And the results of phase II trials include induction chemotherapy or chemoradiotherapy have demonstrated the following: 1) patients who respond either completely or partially to this induction therapy and are down-staged have a better survival. 2) patients with N2 disease at the time of surgery have a disappointing 5-year survival. and 3) patients with incomplete resection are rarely cured of their disease. These induction therapies are tolerable without significant morbidity either during the induction or postoperative phases of treatment. In future, some clinical problems shold be solved as follow; 1) which induction therapy before surgery is most appropriate -chemotherapy alone or chemoradiotherapy?, 2) which induction chemoradiotherapy is most efficacious prior to surgery- chemoradiotherapy or chemotherapy followed by chemoradiotherapy?, 3) what is the role of surgery for persistent N2 disease after induction therapy?, and 4) what is the role of adjuvant treatments following induction therapy and surgery?
key words: Stage III non-small cell lung cancer, Induction chemotherapy, Induction chemoradiotherapy, Surgery, Surgical outcome
JJLC 42 (7): 777-781, 2002
