BUFFALO, NYAlthough adjuvant therapies have made important
inroads into improving overall survival for many cancer patients,
lung cancer patients have not been so fortunate, Robert J. Ginsberg,
MD, said at the Roswell Park Surgical Oncology Symposium.
Previous results of surgery alone or surgery with adjuvant
therapies using chemotherapy, radiotherapy, or their combinations
have been dismal in patients with locally advanced lung cancers,
said Dr. Ginsberg, chief of the Thoracic Service, Memorial
Sloan-Kettering Cancer Center. However, the use of preoperative
or induction chemotherapy, followed by surgery, offers a measure of
hope to some lung cancer patients. In certain instances, he
said, when a complete response is noted at surgery, survival of up to
60% has been achieved.
Most trials of such therapy have included patients with N2 disease,
but, more recently, trials of preoperative chemotherapy have been
reported in patients with earlier stage tumors.
Theoretically, the use of preoperative chemotherapy will decrease the
size of the primary lung cancer tumor, affect the number of
micrometastases, and decrease the odds of seeding cancer cells
throughout the chest cavity during the surgical procedure, Dr.
Preoperative chemotherapy offers us the chance to give patients
the potential benefits of such therapy while they are fit to receive
it. A major problem with lung cancer surgery is the lengthy recovery
time. Because of this, many patients cannot receive adequate adjuvant
treatment. Treating with systemic therapy initially seems to make a
difference, he said.
Disadvantages for such induction therapy are the delay of the initial
surgery, which may disturb patients, and an increase in surgical
morbidity. Although there are some theoretical disadvantages,
it appears that such induction therapy is effective, especially if
the tumor can be downstaged. We do not know yet if the optimal
preoperative treatment is chemotherapy alone or chemotherapy with
radiation therapy, he said.