Skip to main content

Advertisement

SpringerLink
Log in

Neoadjuvant and adjuvant therapy in the management of locally advanced non-small-cell lung cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

The role of adjuvant therapy in non-small-cell lung cancer continues to be defined. We review the most recent major reports of adjuvant trials. Three large randomized trials of postoperative chemotherapy and/or radiation therapy for stage I and II patients have noted improvement trends in median and long-term survival. Two large preoperative phase II trials for stage III A patients have reported high response and surgical resectability rates for preoperative combinations of radiation and chemotherapy, but without significant improvement in survival. In general, most of these protocols require months to complete, and not all patients are able to withstand the associated toxicity. The field of adjuvant therapy is continuing to develop; some of the strategies of ongoing protocols are reviewed.

Résumé

Le rôle de la thérapeutique adjuvante des cancers bronchopulmonaires en dehors des cancers à petites cellules reste à définir. Trois études randomisées importantes ont noté une tendance vers une meilleure survie à moyen et à long terme avec une chimiothérapie et/ou radiothérapie postopératoires pour les cancers stades I et II. Deux études prospectives de phase II ont rapporté une bonne résponse et une amélioration de la résecabilité pour les cancers du stade IIIA avec une combinaison de chimiothérapie et de radiothérapie, mais sans amélioration significative de la survie. En général, la plupart des protocoles nécessitent des mois pour être menées à bon terme et tous les patients ne sont pas capables de tolérer la toxicité. Le domaine de thérapie adjuvante continue à se déveloper: les protocoles actuellement en cours sont passés en revue.

Resumen

El papel de la terapia adyuvante en el manejo del cáncer de células no pequeñas continúa en proceso de definición. Muchos de los ensayos terapéuticos han demostrado tendencias sin significación estadística en cuanto a mejor sobrevida. Con el propósito de valorar si la nueva terapia “experimental” es superior al tratamiento estándar, si los efectos secundarios son tolerables por los pacientes y cuales son los costos en términos de tiempo y toxicidad para la prolongation de la sobrevida, nos propusimos revisar los más recientes informes emanados de ensayos con terapia adyuvante. Tres grandes estudios randomizados de quimio y/o radioterapia postoperatoria en estados I y II han señalado mejoría en la sobrevida a mediano y a largo plazo. Dos ensayos preoperatorios de fase II para pacientes en estado IIIa han informado altas tasas de respuesta y de resecabilidad quirúrgica con la combinación preoperatoria de irradiación y quimioterapia, pero sin mejoría significativa en la sobrevida. En general la mayor parte de estos protocolos requieren meses para ser implementados y no todos los pacientes son capaces de tolerar la toxicidad asociada. El campo de la terapia adyuvante continúa en desarrollo; se revisan las estrategias de algunos de los protocolos en progreso.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mountain, C.F., Lukeman, J.M., Hammar, S.P., Chamberlain, D.W., Coulson, W.F., Page, D.L., Victor, T.A., Weiland, L.H., and The Lung Cancer Study Group Pathology Committee: Lung cancer classification: the relationship of disease extent and cell type to survival in a clinical trials population. J. Surg. Oncol.35:147–156, 1987

    Google Scholar 

  2. Feld, R., Rubinstein, L.V., Weisenberger, T.H., and The Lung Cancer Study Group: Sites of recurrence in resected stage I non-small-cell lung cancer: a guide for future studies. J. Clin. Oncol.2:1352–1358, 1984

    Google Scholar 

  3. Weisenberger, T.H., Gail, M.H., For The Lung Cancer Study Group: Effects of postoperative mediastinal radiation on completely resected stage II and stage III epidermoid cancer of the lung. N. Engl. J. Med.315:1377–1381, 1986

    Google Scholar 

  4. Ferguson, M.K., Little, A.G., Golomb, H.M., Hoffman, P.C., DeMeester, T.R., Beveridge, R., Skinner, D.B.: The role of adjuvant therapy after resection of T1 N1 M0 and T2 N1 M0 non-small cell lung cancer. J. Thorac. Cardioasc. Surg.91:344–349, 1986

    Google Scholar 

  5. Holmes, E.C., Gail, M., for The Lung Cancer Study Group: Surgical adjuvant therapy for stage II and stage III adenocarcinoma and large-cell undifferentiated carcinoma. J. Clin. Oncol.4:710–715, 1986

    Google Scholar 

  6. Lad, T., Rubinstein, L., Sadeghi, A., The Lung Cancer Study Group: The benefit of adjuvant treatment for resected locally advanced non-small-cell lung cancer. J. Clin. Oncol.6:9–17, 1988

    Google Scholar 

  7. Niiranen, A., Niitamo-Korhonen, S., Kouri, M., Assendelft, A., Mattson, K., Pyrhonen, S.: Adjuvant chemotherapy after radical surgery for non-small-cell lung cancer: a randomized study. J. Clin. Oncol.10:1927–1932, 1992

    Google Scholar 

  8. Green, M.R.: New directions for chemotherapy in non-small-cell lung cancer. Chest103(Suppl.):370S-372S, 1993

    Google Scholar 

  9. Perez, C.A., Stanley, K., Grundy, G., Hanson, W., Rubin, P., Kramer, S., Brady, L.W., Marks, J.E., Perez-Tamayo, R., Brown, G.S., Concannon, J.P., Rotman, M.: Impact of irradiation technique and tumor extent in tumor control and survival of patients with unresectable non-oat cell carcinoma of the lung: report by the Radiation Therapy Oncology Group. Cancer50:1091–1099, 1982

    Google Scholar 

  10. Ihde, D.C., Minna, J.D.: Non-small cell lung cancer. Part II: treatment. Curr. Probl. Cancer15:105–154, 1991

    Google Scholar 

  11. Strauss, G.M., Surgarbaker, D.J.: Treatment for regionally advanced non-metastatic N.S.C.L.C. Oncol. Bull.16:5–19, 1993

    Google Scholar 

  12. Mountain, C.F.: A new international staging system for lung cancer. Chest.89(Suppl.):225S-233S, 1986

    Google Scholar 

  13. American Joint Committee For Cancer Staging and End-Results Reporting Task Force on Lung: Staging of Lung Cancer 1979. Chicago, American Joint Committee for Cancer Staging and End Results Reporting, 1979, pp. 1–35

  14. Martini, N., McCaugham, B., Bains, M.S.: Improved survival in resection for selected stage III lung cancer. Lung Cancer2:97, 1986(Abstract)

    Google Scholar 

  15. Ginsberg, R.J.: Multimodality therapy for stage IIIA (N2) lung cancer: an overview. Chest103(Suppl.):356S-359S, 1993

    Google Scholar 

  16. Martini, N., Flehinger, B.J.: The role of surgery in N2 lung cancer. Surg. Clin. North Am.67:1037–1049, 1987

    Google Scholar 

  17. Pearson, F.G., DeLarue, N.C, Ilves, R., Todd, T.R.J., Cooper, J.D.: Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J. Thorac. Cardiovasc. Surg.83:1–11, 1982

    Google Scholar 

  18. Shields, T.W.: Preoperative radiation therapy in the treatment of bronchial carcinoma. Cancer30:1388–1394, 1972

    Google Scholar 

  19. Warram, J., for the Collaborative Investigators: Preoperative irradiation of cancer of the lung: final report of a therapeutic trial, a collaborative study. Cancer36:914–925, 1975

    Google Scholar 

  20. Sherman, D.M., Neptune, W., Weichselbaum, R., Order, S.E., Piro, A.J.: An aggressive approach to marginally resectable lung cancer. Cancer41:2040–2045, 1978

    Google Scholar 

  21. Marangolo, M., Fiorentini, G.: Adjuvant chemotherapy of non-small cell lung cancer: a review. Semin. Oncol.15(Suppl 7):13–17, 1988

    Google Scholar 

  22. Weiden, P.L., Piantadosi, S., for The Lung Cancer Study Group: Preoperative chemotherapy (cisplatin and fluorouracil) and radiation therapy in stage III non-small-cell lung cancer: a phase II study of the Lung Cancer Study Group. J. Natl. Cancer Inst.83:266–272, 1991

    Google Scholar 

  23. Strauss, G.M., Herndon, J.E., Sherman, D.D., Mathisen, D.J., Carey, R.W., Choi, N.C, Rege, V.B., Modeas, C., Green, M.R.: Neoadjuvant chemotherapy and radiotherapy followed by surgery in stage IIIA non-small-cell carcinoma of the lung: report of a Cancer and Leukemia Group B Phase II Study. J. Clin. Oncol.10:1237–1244, 1992

    Google Scholar 

  24. Ihde, D.C., Minna, J.D.: Non-small cell lung cancer. Part I: biology, diagnosis, and staging. Curr. Probl. Cancer15:61–104, 1991

    Google Scholar 

  25. Faber, L.P., Bonomi, P.D.: Combined preoperative chemoradiation therapy. Chest Surg. Clin. North Am.1:43–59, 1991

    Google Scholar 

  26. Martini, N., Kris, M.G., Gralla, R.J., Bains, M.S., McCormack, P.M., Kaiser, L.R., Burt, M.E., Zaman, M.B.: The effects of preoperative chemotherapy on the resectability of non-small cell lung carcinoma with mediastinal lymph node metastases (N2M0). Ann. Thorac. Surg.45:370–379, 1988

    Google Scholar 

  27. Burkes, R.L., Ginsberg, R.J., Sheperd, F.A., Blackstein, M.E., Goldberg, M.E, Waters, P.F., Patterson, G.A., Todd, T., Pearson, F.G., Coopee, J.D., Jones, D., Lockwood, G.: Induction chemotherapy with mitomycin, vindesine, and cisplatin for stage III unresectable non-small-cell lung cancer: results of the Toronto Phase II Trial. J. Clin. Oncol.10:580–586, 1992

    Google Scholar 

  28. Pass, H.I., Pogrebniak, H.W., Steinberg, S.M., Mulshine, J., Minna, J.: Randomized trial of neoadjuvant therapy for lung cancer: interim analysis. Ann. Thorac. Surg.53:992, 1992

    Google Scholar 

  29. Sugarbaker, D.J., Strauss, G.M.: Advances in surgical staging and therapy of non-small cell lung cancer. Semin. Oncol.20:163–172, 1993

    Google Scholar 

  30. Kaplan, R.M., Bush, J.W., Berry, C.C.: Health status: types of validity and the index of well-being. Health Serv. Res.11:478–507, 1976

    Google Scholar 

  31. McDowell, I., Newell, C.: Measuring Health: A Guide To Rating Scales And Questionnaires. New York, Oxford University Press, 1987, pp. 204–227

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Thoracic Surgery, Brigham

    Michael T. Jaklitsch M.D. & David J. Sugarbaker M.D.

  2. Department of Hematology/Oncology, Brigham

    Gary M. Strauss M.D.

  3. Women's Hospital, 75 Francis Street, 02115, Boston, MA, USA

    Michael T. Jaklitsch M.D. & David J. Sugarbaker M.D.

  4. Dana Farber cancer Institute, 75 Francis Street, 02115, Boston, MA, USA

    Michael T. Jaklitsch M.D. & David J. Sugarbaker M.D.

Authors
  1. Michael T. Jaklitsch M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gary M. Strauss M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David J. Sugarbaker M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jaklitsch, M.T., Strauss, G.M. & Sugarbaker, D.J. Neoadjuvant and adjuvant therapy in the management of locally advanced non-small-cell lung cancer. World J. Surg. 17, 729–734 (1993). https://doi.org/10.1007/BF01659082

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01659082

Keywords

Search

Navigation