According to a combined analysis of previously published studies, pre-operative chemotherapy improves survival among patients with non–small cell lung cancer. These results were published in the Cochrane Database of Systematic Reviews.

Lung cancer remains the leading cause of cancer-related deaths in the United States. Non–small cell lung cancer (NSCLC) refers to the most common type of lung cancer, accounting for approximately 75–80% of all lung cancers in the U.S.

For patients who are candidates for surgery, surgery plays an important role in the treatment of NSCLC. Giving chemotherapy before surgery may improve treatment outcomes by shrinking the tumor and allowing for easier or more complete surgery. Chemotherapy may also allow some patients with initially inoperable cancer to become candidates for surgery. Finally, preoperative chemotherapy may provide early treatment of undetectable areas of cancer that have spread beyond the lungs.

A potential concern about the use of preoperative chemotherapy is that it delays surgery. If preoperative chemotherapy is ineffective, delaying surgery could allow the cancer to grow or spread.

To compare treatment with chemotherapy followed by surgery to surgery alone, researchers combined information from seven previously published clinical trials. These trials enrolled a total of 988 patients.

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  • Patients treated with chemotherapy followed by surgery survived longer than patients treated with surgery alone. Five-year survival was 20% among patients treated with chemotherapy followed by surgery and 14% among patients treated with surgery alone.

These results suggest that chemotherapy followed by surgery may result in better survival than surgery alone in patients with NSCLC.

The researchers caution that these results are based on a relatively small number of patients. Furthermore, it’s still unclear whether there are particular subgroups of patients who are most likely to benefit from pre-operative chemotherapy.

Reference: Burdett SS, Stewart LA, Rydzewska L. Chemotherapy and surgery versus surgery alone in non–small cell lung cancer. Cochrane Database of Systematic Reviews. 2007;3:CD006157.

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