The Role of Induction (Neoadjuvant)Chemotherapy in Stage IIIA NSCLC*

Induction (neoadjuvant) chemotherapy has become an accepted treatment for stage IIIA(T1-3N2M0) non-small cell lung cancer. In two recent randomized trials, neoadjuvant chemother¬ apy plus surgery gave an increase in median survival at least fivefold greater than surgery alone. The Spanish Lung Cancer Group trial of preoperative chemotherapy, in which the cisplatin dose was randomized to either 50 mg/m2 or 100 mg/m2 plus 3 g/m2 ifosfamide and 6 mg/m2 mitomycin, ex¬ amines the effect of K-ras gene mutations on tumor response and survival. Patients whose tumors contain K-ras gene mutations are more likely to develop distant metastases and have lower median survival than patients without such mutations. Microsatellite instability seems to be a frequent mechanism of genetic aberrations. Knowledge about these genetic alterations could have prognos¬ tic importance and may identify the patients who should receive the most aggressive additional treatment. (CHEST 1996; 109:102S-106S) "Patients with stage IIIA non-small cell lung cancer-*- (NSCLC) comprise a complex and heterogeneous group, with a median survival of12 months and a 5-year survival rate of 15%. Striking differences in outcome are observed, with the prognosis being better for T3 tumors based on chest wall invasion and no nodal in