Is an evidence-based approach unrealistic in NSCLC?

Summary
Non-small cell lung cancer (NSCLC) is a heterogeneous tumour. A wide variety of treatment
options is currently available. Surgery remains the mainstay of curative treatment and an operative approach will be selected in function of disease stage, tumour resectability and performance status of the patient. Adjuvant
chemotherapy is considered standard at least
for stage II and III disease. In stage III disease,
resectability should be decided in function of the cytological/histological confirmation of N2 disease. If N2-disease cannot be highlighted at work-up, the patients are submitted to surgery followed by adjuvant chemotherapy.
If patients are staged pN0-pN1 after surgery, ostoperative radiotherapy should not be given. However, if pN2 is discovered at surgery, there might be a place for postoperative radiotherapy but this still needs confirmation.
In case of cytological/histological confirmation of pN2 disease prior to surgery, patients should not be operated but treated with a combination of oncomitant chemoradiotherapy.
This treatment algorithm will be evaluated by reviewing the published evidence issued from randomized controlled trials.