With the progression of chemotherapy (CT)and radiotherapy (RT), multidisciplinary measures in surgical treatment of lung cancer has become a hot subject for research. The chairman of ASCO, Dr. Bunn, pointed out that all kinds of cancers should be treated with multidisciplinary methods. Neoadjuvant chemotherapy is standard for care of Ⅲa N 2 NSCLC in Europe and U.S.A., but a large randomized trial was needed to confirm this hypothesis. At the 2003 ASCO meeting, Dr. Le Chevalier reported the result of the randomized international adjuvant lung cancer trial for 1867 resected NSCLC. 2 and 5 yr survival rates, progression free survival (PFS) were superior for the adjuvant CT group. Shanghai Lung Cancer Team studied 211 cases of rescected NSCLC with multi variant cox analyses. The result shows post operation chemotherapy might be beneficial to survival. Besides, in the cases with ≥3 cycles of post operation CT have better survival rates than less cycles. Patients with stage Ⅲa NSCLC and clinical or pathologically confirmed N 2 nodes (pN 2) have a poor prognosis after surgery of RT. Surgical resection after induction CT or CT/RT yields encouraging results in phase Ⅱ trials, but its role is controversial. Dr. Albain reported 429 cases of resectable Ⅲa (pN 2)NSCLC divided into CT/RT/S and CT/RT groups. CT/RT followed by surgery yields superior MST, 3-year survival rates and PFS, but there were more non cancer deaths in CT/RT/S group. The benefit reported could prevent annually-7,000 deaths worldwide.

As we know a poor prognosis is seen in locally advanced NSCLC treated with surgery, there have some consistencies and controversies found in a number of surgical studies. Consistency: Incomplete resection of tumor and central T3 tumor have poor 5-yr survival, T3 with N, has a worse long-term survival rate than with N0. Mediastinal lymph node metastasis N2 is known as the most important prognostic factor in stage Ⅲ NSCLC, multiple node stations, location and extra-capsular nodal extension of tumor are unfavorable prognostic indicatiors. Preoperative induction chemotherapy may improve the complete resection and survival of stage M NSCLC, but more multicenter randomized studies are needed to be further study. T4, N, Mb NSCLC are known as having quite a poor prognosis and low resectability. Controversy: Clinical image staging is a noninvasive method to look for intrathoracic lymph node, but it is not as accurate as mediastinoscopy. Post-operative radiotherapy has a lower relapse rate but no benefit to survival. Pre-operative radiotherapy of pancoast tumor has a higher complication rate. 30% of intrathoracic nodes have skip N2 metastasis, thus, careful dissection of all the nodes stations and sample it sent to pathology is necessary. Pneumonectomy is not beneficial to the survival of pN2. Carinaectomy is not suitable for those patients with N1, N2. Malignant pleural effusion is basically a nonsurgical disease.

Malignant mesothelioma is an aggressive malig na ncy that may be caused by environmental carcinogens(asbestos),viruses(SV40),and genetic predisposition.Diagnosis relies on radiographic studies as well as patho logy and mdecular bidogy tests.Most such patients are not suitable for surgical or radiotherapy treatment,and cytotoxic agents are the only options.Historically ,no single or combinations of agents consistently yielded response rates over 20 %.Recently,pemetrexed,a folate-based inhibitor of thymidylate synthase,has been evaluated in phase Ⅰ,ⅡandⅢ clinical trials with promising results.Moreover, low-dose folic acid and vitamin B 12 supplementation significantly reduced the toxicity observed with the use of pemetrexed.In light of these data,it is l ikely that pemetrexed/cisplatin will soon be recommended for malignant pleural m esothelioma as first-line standard chemotherapy.

For advanced lung cancer,multimodality treatment is the main stream.Patients with locally advanced disease may have long-term survival rate with radiation therapy combined with chemotherapy.Patients with advanced metastatic disease may achieve improved survival and palliation of symptoms with chemotherapy.Here we reviewed the recent development in treatment for advanced non-small cell lung cancer.

Purpose:To evaluate the effects of thymosin ?1 (T?1) in chemotherapy of NSCLC. Methods:We have conducted a prospective randomized controlled clinical trial.40 non-treated cases of stage Ⅲ-Ⅳ NSCLC were randomized into T?1 group ( chemotherapy combined with thymosin ?1) and control group (chemotherapy alone). The number of T cell subgroups, the activity of NK cell and phagocytic index of neutrophilic granulocyte in peripheral blood were detected and quality of life and changes of cancer lesions were evaluated before and after treatment. Results:After treatment,the levels of CD4 in the T?1 group was significantly higher than before treatment(P0.05). There was no significant difference of myelosuppression between the two groups. No infections or severe toxicity occurred in the T?1 group. One severe lung infection was seen in the control group.There was better quality of life for the T?1 group compared with the control group(P

Purpose:To evaluate the effect of cisplatin-based peri-operation chemotherapy (CT) on survival after completed resection of non small cell lung cancer (NSCLC)Methods:A prospective, randomized, multicenter study was conducted by Shanghai Lung Cancer Team since Feb 1995 to Dec 2003 for stage Ⅰ~ⅢA NSCLC with completed resection. Patients were randomly assigned to receive pre-operative CT or no pre-operative CT (pre-op CT). Post-operative CT (post-op CT) were used for majority of the patients, except for partial stage I patients. Accumulated survival, log rank, MST, Cox uni-variance and multi-variance analyses, HR were used as statistics for evaluation Results:A total of 337 patients underwent randomization, 169 cases received pre-operative CT, and 168 cases didn't receive pre-operative CT. There was statistical survival difference between the group with no pre-op CT and with pre-op CT, 5-yr survival rate were of 47.85%∶ 36.52%, MST were 56.63∶39.14(P=0.03), respectively. Stage and post-op CT were the only two meaningful parameters with statistical survival difference calculated by multi-variance analyses (P0.05). There were 121 cases received more than 3 cycles post-op CT, 216 cases received less than 3 cycles post-op CT. The patients received more than 3 cycles had better yr-survival and MST than those received less cycles (P=0.04).Post-op CT was not benefit to the survival rate of stage I. In stage Ⅱ and ⅢA ,the patients received ≥3 cycles post-op CT had better yr-survival than those received less cycles(P

Purpose:To study the effectiveness and safety o f first-line chemotherapy with GEM-Cis 3-week regimen in routine care of Chin ese patients with advanced NSCLC. Methods:Gem-Cis 3-week regimen was used as first line chemoth erapy to treat stage Ⅲb/Ⅳ NSCLC patients, measurements of effectiveness includ ed clinical benefit and significant clinical response (SCR), and side events of GEM-Cis in the treatment of stage Ⅲb/IV NSCLC. Results:221 patients with cytological or pathological confirmed stage Ⅲb or IV NSCLC were enrolled, 209 eligible for effectiveness and safety analysis. Median age 58 years (range, 29 to 79 years); males: females, 67.5%∶ 32.5%; stage Ⅳ: ⅢB, 52.5%∶47.8 %; KPS