Use of adjuvant chemotherapy in non-small cell lung cancer in routine practice

Background: For many years, surgery has been the standard treatment for patients with early-stage non-small cell lung cancer (NSCLC). Recent randomized trials demonstrated that cisplatin-based adjuvant chemotherapy increases overall survival. The aim of this study was to analyze the precise use of adjuvant chemotherapy in patients with resected NSCLC in routine practice. Patients and Methods: Between January 2004 and May 2005, we retrospectively analyzed 219 patients with early-stage NSCLC who had undergone surgery at one major surgical center in Paris, Institut Mutualiste Montsouris. Patient characteristics, the type of surgery, and indications for adjuvant chemotherapy were analyzed. Results: Eighty-seven of the 219 patients (40%) in this study had been treated with adjuvant chemotherapy. Different factors were associated with doctors not prescribing this treatment: age, comorbidity, tumor, node, metastasis stage, and postoperative complications. More than eight different cisplatin-based regimens were used, highlighting considerable heterogeneity in the use of adjuvant chemotherapy in daily practice. There is an increase of adjuvant chemotherapy during the study period. Conclusion: Cisplatin-based chemotherapy is the standard treatment for patients with resected stage II and IIIA NSCLC. However, such therapy is used quite heterogeneously in daily practice and specific regimens, and the percentage of patients receiving adjuvant chemotherapy vary from standard recommendations. A prospective follow-up of daily practice regarding the use of adjuvant chemotherapy is warranted.