Adjuvant therapy for non-small cell lung cancer with mediastinal nodal involvement.

Since the publication of the meta-analysis in 1995 indicating a potential survival benefit with adjuvant cisplatin-based chemotherapy for patients with resected NSCLC, the management of patients with resected NSCLC and N2 disease involvement has evolved dramatically. The delivery of systemic therapy in the postoperative setting remains difficult, however, because tolerance for the toxicities of chemotherapy is reduced by recovery from surgery itself. Even with a proven survival benefit with adjuvant chemotherapy, cure is not guaranteed, and most patients die from relapse of their cancer. Optimization of treatment through the administration of neoadjuvant therapy, application of more modern radiotherapy techniques, and combined-modality therapy with chemoradiation or molecularly targeted agents are areas currently under active investigation. Ideally, the improvement of prediction of which patients harbor micrometastatic disease before undergoing surgical resection and the prediction of which patients would benefit from different systemic therapies may help to improve further the chance of cure for NSCLC while at the same time reducing toxicity.