Chemotherapy before Surgery May Improve Survival for Persons

Chemotherapy before Surgery May Improve Survival for Persons with Early-Stage Non-Small Cell Lung Cancer

Persons with non-small cell lung cancer often receive surgery as their primary treatment. Because the cancer frequently return following surgery, additional treatment with chemotherapy and/or radiation therapy is administered to help prevent cancer recurrence and improve survival. Now, researchers report that administering chemotherapy before the surgery may be beneficial.

Non-small cell lung cancer (NSCLC) is a term used to describe several types of lung cancer, including epidermoid or squamous carcinoma, adenocarcinoma, large cell carcinoma, adenosquamous carcinoma, and undifferentiated carcinoma. Treatment options for NSCLC may include surgery, radiation therapy, and/or chemotherapy, depending on the stage of the cancer (extent of disease at diagnosis).

Stage I NSCLC is cancer that is confined to the lung.

Stage II NSCLC is characterized by cancer of the lung that has spread to nearby lymph nodes.

Stage III NSCLC is cancer that originated in the lung and then spread to the chest wall or diaphragm; or the lymph nodes in the mediastinum (area between the 2 lungs); or to the lymph nodes in the neck or opposite side of the chest.

Stage IIIA NSCLC can often be treated with surgery, while stage IIIB disease often cannot. Although many persons with early-stage NSCLC can be treated with surgery alone, there may be a few undetectable cancer cells that have spread outside the lung—cancer cells that may grow and cause a recurrence (return) of the cancer later. For this reason, researchers have been developing and studying new strategies to help prevent a cancer recurrence and improve survival.

The use of chemotherapy after surgery (called adjuvant therapy) for early stage NSCLC has been studied, but has not been consistently shown to be of benefit. However, the use of chemotherapy before surgery (called neoadjuvant therapy) may be a more promising approach. It is thought that neoadjuvant chemotherapy may help prevent a recurrence by killing cancer cells that have spread outside the lung and may also reduce the cancer in size, allowing for a more successful surgery. One previous study showed that a mitoxantrone/ifosfamide/cisplatin chemotherapy combination followed by surgery was more effective than surgery alone for persons with early-stage NSCLC. Given these findings, researchers from several medical centers evaluated the use of a new neoadjuvant chemotherapy combination.

Researchers from several U.S. medical centers treated 94 persons with stage I to IIIA NSCLC with a chemotherapy combination of paclitaxel and carboplatin, followed by surgery to remove the cancer. Those who had complete responses after surgery also received 3 additional cycles of chemotherapy. After the patients received the initial chemotherapy, 56% had a major response and 94% underwent subsequent surgery. Eighty-six percent had complete surgical removal of all visible cancer. After 1 year, 85% of the patients survive.

These findings suggest that this new treatment approach is both feasible and promising. The researchers indicated that the use of paclitaxel and carboplatin, followed by surgery, may be the most effective combined-therapy approach to treating early-stage NSCLC. Further studies to compare this regimen directly with surgery alone are needed. Persons who have stage I to IIIA NSCLC may wish to talk with their doctor about the risks and benefits of receiving chemotherapy before surgery or of participating in a clinical trial in which other promising new treatments are being studied. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (www.411cancer.com). (Journal of Thoracic and Cardiovascular Surgery, Vol 119, No 3, pp 429-439, 2000)

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