Skip to content

    Lung Cancer Health Center

    Font Size

    Non-Small Cell Lung Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stages IIA and IIB NSCLC Treatment


    Limitations of evidence (surgery):

    Conclusions about the efficacy of surgery for patients with local and locoregional NSCLC are limited by the small number of participants studied to date and potential methodological weaknesses of the trials.

    Neoadjuvant chemotherapy

    The role of chemotherapy prior to surgery was tested in clinical trials. The proposed benefits of preoperative chemotherapy include the following:

    • A reduction in tumor size that may facilitate surgical resection.
    • Early eradication of micrometastases.
    • Better tolerability.

    Preoperative chemotherapy may, however, delay potentially curative surgery.

    Evidence (neoadjuvant chemotherapy):

    1. The Cochrane Collaboration Review group reported a systematic review and meta-analysis of seven randomized controlled trials that included 988 patients and evaluated the addition of preoperative chemotherapy to surgery versus surgery alone. These trials evaluated patients with stages I, II, and IIIA NSCLC.[3]
      • Preoperative chemotherapy provided an absolute benefit in survival of 6% across all stages of disease, from 14% to 20% at 5 years (HR, 0.82; 95% CI, 0.69-0.97; P = .022).[3][Level of evidence: 1iiA]
      • This analysis was unable to address questions such as whether particular types of patients may benefit more or less from preoperative chemotherapy.
    2. In the largest trial reported to date, 519 patients were randomly assigned to receive either surgery alone or three cycles of platinum-based chemotherapy followed by surgery. Most patients (61%) had clinical stage I disease; 31% had stage II disease; and 7% had stage III disease.[4]
      • No survival advantage was seen.[4]
      • Postoperative complications were similar between groups, and no impairment of quality of life was observed.
      • There was no evidence of a benefit in terms of overall survival (OS) (HR, 1.02; 95% CI, 0.80-1.31; P = .86).
      • Updating the systematic review by addition of the present result suggests a 12% relative survival benefit with the addition of neoadjuvant (preoperative) chemotherapy (1,507 patients; HR, 0.88; 95% CI, 0.76-1.01; P = .07), equivalent to an absolute improvement in survival of 5% at 5 years.

    Adjuvant radiation therapy

    The value of postoperative (adjuvant) radiation therapy (PORT) has been evaluated.[5]

    1 | 2 | 3 | 4
    Next Article:

    Today on WebMD

    Xray analysis
    Do you know the myths from the facts?
    chest x-ray
    Get to know them.
    woman taking pills
    Tips to managing them.
    Lung cancer xray
    See it in pictures, plus read the facts.
    Lung Cancer Risks Myths and Facts
    Woman getting ct scan
    Improving Lung Cancer Survival Targeted Therapy
    cancer fighting foods
    Lung Cancer Surprising Differences Between Sexes
    Pets Improve Your Health
    Vitamin D
    Lung Cancer Surgery Options