THE ROLE OF CHEMOTHERAPY IN THE TREATMENT OF STAGE-III NON-SMALL-CELL LUNG-CANCER (NSCLC)

For the majority of patients in stage III non-small lung cancer (NSCLC), the therapy most generally in use today (radiotherapy and/or surgery) is less than adequate. Local recurrences and distant metastases continue to be the rule even in most of the radically operated patients. Clinical studies do demonstrate, however, that in stage III NSCLC prognosis can be improved by using chemotherapy within multi-modal treatment regimens. Hope has thus arisen that through the early application of chemotherapy, the formation of metastatic disease can be prevented in the micrometastatic stage. It would even seem possible that by using early systemic therapy the size of the primary tumor can be reduced, thus allowing for better local control through surgery or radiotherapy. Combination chemotherapy regimens which contain cisplatin appear to be the systemic treatment of choice for this purpose, since they offer good chances for achieving a partial or complete tumor regression. Used sequentially or simultaneously with radiotherapy, combination chemotherapy produces a significant reduction in the incidence of distant metastases, but at the same time seems to be unable to reduce the high risk for local recurrence. In order to achieve better results it would appear that surgery must be encorporated into the multi-modal treatment concept. Various pilot and feasibility studies show that best results can be obtained when chemotherapy with or without irradiation is used as induction therapy. According to our own experiences such an approach may allow for better prognosis in stage III NSCLC, resulting in an increase in the number of long-term survivors, the number of operable patients, and the number of patients with resectable tumors. In order to draw attention to the possibilities of multi-modality therapy, this paper will not only present data from a clinical study done in our hospital but will also discuss encouraging results from other recent investigations.