Induction chemotherapy with/without radiation followed by surgery in stage III non-small-cell lung cancer.

The objectives of this review are to provide an update and perspectives on the use of induction therapy (chemotherapy with or without radiotherapy) followed by surgery in two subgroups of patients with stage III non-small-cell lung cancer. The first subset is that of bulky stage IIIAN2 or IIIB disease (standard treatment: chemoradiotherapy), and the second, minimal stage IIIA non-N2 or computed tomography (CT)-negative N2 disease (standard therapy: initial surgical resection). Details of recent major trials in each of these two subsets are provided regarding selections criteria, study design, toxicity, resection rates, median and long-term survival, and predictors of survival. The review concludes with a discussion of whether consensus has emerged about the addition of surgery after induction chemoradiotherapy in the group with bulky disease and whether there should now be a standard recommendation for preoperative chemotherapy with or without radiotherapy in patients with initially resectable tumors.