Stage IIIA NSCLC with limited N2 disease: Ιnduction chemotherapy and reseption or surgical treatment and adjuvant chemotherapy?

The ideal treatment of stage IIIA NSCLC with limited N2 disease still remains unclear. The multimodality treatment approach with combined chemotherapy and surgery and possible addition of radiotherapy appears to yield the best results. 

Ideally, we could identify somehow in advance the patients who would benefit from the administration of induction chemotherapy (probably patients with micrometastases) opposed to those who will not show any benefit (e.g. resistant to chemotherapy or patients who are free of micro-metastases), so that they are lead directly and without any delay to the operating room to undergo lung resection surgery.

The rapid development of molecular biology in the diagnosis and treatment of lung cancer provides expectations that in the near future we will be able to provide more accurate personalized treatment in a disease that despite recent advances still has high mortality.

The answer to the question “which patients will undergo chemotherapy and with which drugs?” seems to be given by the application of methods in the everyday clinical practice which aim to the detection of more accurate prognostic and molecular indicators retraced in the biopsy material or in the excised tumors.

In conclusion, we can support the view that for stage IIIA NSCLC with limited N2 disease the better designed and therefore more reliable studies failed to show a clear statistically significant difference between the available treatments. The radical surgical excision of the tumor, that is to say the removal of the whole macroscopic disease, remains the cornerstone in the multifactorial treatment of stage IIIA lung cancer. In the future, the administration of chemotherapy either as induction or as adjuvant (postoperative) will be determined by the Molecular Biology, which considering the biological aggressiveness of the tumors, will actually perform biological staging of the disease, in addition to the existing anatomical (TNM).