Induction treatment before surgery for non-small cell lung cancer

Preoperative chemoradiation approaches to locally advanced non-small-cell lung cancer: one man’s pride, another man’s burden?

“…'T4') or either distant risks ('N2/N3' or 'large tumour burden') [7,8]. Any comprehensive judgement of treatment strategies has to acknowledge this marked heterogeneity.…”

“…3 There may be subsets of patients that may profit from definitive surgery, but these subsets have not yet been clearly defined. There is some evidence that selected T4N0-1 patients should be taken to definitive thoracotomy [5,8]. Other patients groups, including those with important co-morbidities, may have the best chance of cure and long-term survival with bi-modality protocols of concurrent chemoradiotherapy.…”

“…While there are no generally accepted standards of care in the treatment of locally advanced NSCLC [8], we will be left with a situation in which the selection of patients to protocols based on permutations of chemotherapy, radiotherapy and surgery will predominantly be based on the experience and logistics of the treatment centre and its participating experts. Since there is a marked heterogeneity of 'patients' as well as 'doctors' in the treatment of stage III disease (patient substages, patient co-morbidity profiles, centre logistics, centre experience), this will lead to a situation in which the treatment protocol will largely remain 'one man's pride', but may also turn out as 'another man's burden'.…”

“…Peri-and postoperative deaths are constantly observed in between 2% and 11% of patients put on clinical trials with induction therapy followed by definitive surgery, even in centres who have developed the logistics and the experience to handle such complex protocols [5][6][7][8][9][10]. Objective data analyses of risk factors derived from the co-morbidity profiles of the treated patient populations within this setting are still very rare [8,10]. As a major risk factor, performance of pneumonectomy (especially right-sided) has been identified [6,8,10,11].…”

“…Objective data analyses of risk factors derived from the co-morbidity profiles of the treated patient populations within this setting are still very rare [8,10]. As a major risk factor, performance of pneumonectomy (especially right-sided) has been identified [6,8,10,11]. Not sufficiently well documented, so far, is a probable learning effect that may lower this risk as the experience gained by the interdisciplinary multimodality team increases over time.…”