Postoperative adjuvant therapy for patients with resected non-small cell lung cancer: still controversial after all these years

Patients with clinical stage I and II non-small cell lung cancer (NSCLC) generally are considered candidates for surgical resection, with cure rates as high as 80% reported for some subsets, Locoregional and systemic adjuvant therapies have been evaluated in patients with lymph node involvement or pathologic T3 status, although considerable controversy regarding an appropriate standard of care continues to exist. Several trials have evaluated postoperative radiation therapy, the majority of which suggest that overall survival may be only minimally improved with this adjuvant therapy, but local failure is probably reduced. Trials evaluating the role of adjuvant chemotherapy have been few, often enrolling small numbers of patients. Several recent reviews summarizing the results of these trials suggest that, although some adjuvant chemotherapy regimens may have biological activity, results have not been consistent, and further study is warranted for regimens that include newer chemotherapy agents. CNS relapse is one of the most common sites of metastasis in NSCLC, and prophylactic cranial irradiation (PCI) has been evaluated in a number of trials to reduce the risk of local failure at this site. Data from these trials strongly suggest that a prospective trial of PCI in patients with NSCLC at high risk for isolated CNS relapse is warranted. Future clinical trials evaluating new radiographic, immunologic, and molecular technologies for early detection of second primary tumors also should be considered, particularly in patients with resected T1N0M0 lesions.