Despite surgical removal of the primary cancer, the majority of patients with stage I to IIIA non small cell lung cancer ultimately experience cancer recurrence. In an attempt to reduce the risk of cancer recurrence, patients have been treated with adjuvant chemotherapy and/or radiation therapy following surgical removal of the cancer. Unfortunately, many patients are unable to receive treatment after surgery. Comparative clinical studies have not currently demonstrated a benefit to routinely administering post-operative adjuvant therapy.

Some doctors have advocated giving preoperative, or neoadjuvant, chemotherapy to patients with early stage lung cancer in order to reduce the risk of cancer recurrence. The theoretical advantage of delivering preoperative chemotherapy is that all patients actually receive chemotherapy immediately, thereby increasing the chance of destroying any cancer cells that may have left the lung. Additionally, the primary cancer may be reduced in size and more easily removed by surgery.

In order to determine the value of preoperative chemotherapy as a treatment for early stage non small cell lung cancer, doctors in France treated 373 patients between July 1991 and April 1997 with stage IB, II, or IIIA non-small cell lung cancer. Patients were equally divided between treatment strategies consisting of surgery alone or mitoxantrone, ifosfamide, and cisplatin chemotherapy followed by surgery. All patients with large cancers or extensive lymph node involvement were also treated with radiation following surgery.

Using this treatment approach, all patients were able to receive chemotherapy and 11% of patients treated with chemotherapy achieved a documented complete disappearance of their cancer before surgery. Patients treated with chemotherapy, however, were more likely to experience side effects following surgical treatment. Analysis of patients 3 years from initiation of therapy revealed that patients treated with the preoperative chemotherapy approach were more likely to survive than patients treated with surgery alone. The 3-year survival rate was 49% for patients treated with chemotherapy and surgery compared to 41% for patients treated with surgery alone. More importantly, patients treated with preoperative chemotherapy were more likely to be alive without evidence of cancer recurrence.

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In summary, this clinical study suggests that preoperative, or neoadjuvant, chemotherapy may prolong survival and reduce the risk of cancer recurrence compared to the historical standard treatment of surgery alone for patients with early stage non small cell lung cancer. Additional clinical trials designed to confirm the value of preoperative chemotherapy are ongoing. Doctors will also continue to evaluate newer chemotherapeutic agents in combination with radiation in attempts to further improve patient outcomes. (American Society of Clinical Oncology, Abstract 1792, 1999)

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