Introduction In the early 1980s, a hesitant and careful start was made for neoadjuvant chemotherapy in stage III non–small-cell lung cancer (NSCLC) 1 at a time when a lively discussion was on- going about the presence or absence of any value of chemo- therapy in NSCLC. Approximately 10 years later, neoadjuvant chemotherapy in NSCLC has become an exciting area of clin- ical research because of the prospect of an improved cure rate in a subset of patients by application of combined modality treatment. Important milestones in the past 10 years were: 1) new classifications of NSCLC in 1986 and 1997 by Mountain 2,3 ; 2) the results of the meta-analysis on randomized trials of chemotherapy in NSCLC, performed between 1965 and 1990 4 ; 3) the results of 18 randomized trials of combined modality treatment versus single modality treatment in stage III NSCLC, published after 1990 5 ; and 4) the consensus on practical clinical guidelines for the treatment of unresectable locally advanced NSCLC, published by the American Society of Clinical Oncology (ASCO) in 1997. 6 The conclusion of the ASCO con- sensus was that "standard treatment for a selected group of pa- tients with stage III NSCLC consists of 2 or more courses of cisplatin-based neoadjuvant chemotherapy with concurrent or sequential radiotherapy." In the literature, increases in 5-year survival rates by combined modality treatment have been re- ported, varying from 10% to 20%. 7-9 Important issues for future research on combined modality treatment in stage III NSCLC are: - Which modality or combination of modalities offers the best local control and thereby the best survival after neoadjuvant chemotherapy? - What is the most effective neoadjuvant chemotherapy regimen (combination of drugs, dose, schedule, number of courses) to eradicate distant micrometastases? - Which subgroups of patients with stage III NSCLC benefit from combined modality treatment? - What is the best sequence of modalities? In December 1994, the European Organization for Research and Treatment of Cancer (EORTC) initiated a multicenter ran- domized trial (EORTC 08941) to compare the efficacy of sur- gery versus radiotherapy after neoadjuvant chemotherapy in 69 August 2000 brief communicatio n T.A.W. Splinter, 1 P.E. van Schil, 2 G.W.P.M. Kramer, 3 J. van Meerbeeck, 1 A. Gregor, 4 P. Rocmans, 5 A. Kirkpatrick 6 Abstract Combined modality treatment of patients with stage III non–small-cell lung cancer (NSCLC) has recently become widely accepted. Standard combinations are neoadjuvant chemotherapy followed by radiotherapy or concurrent chemotherapy and radiotherapy. The effect of combined modality treatment on survival is dependent on both the efficacy of chemotherapy to eradicate micrometastases and optimal local control. The European Organization for Research and Treatment of Cancer (EORTC) Lung Cancer Cooperative Group has chosen to investigate in a comparative way the side effects and the effect on survival of radiotherapy versus surgery in stage IIIA (N2) NSCLC. Clinical Lung Cancer, Vol. 2, No. 1, 69-72, 2000 Key words: Non–small-cell lung cancer, Stage IIIA (N2), Neoadjuvant chemotherapy, Radiotherapy, Surgery, Combined modality treatment Randomized Trial of Surgery Versus Radiotherapy in Patients with Stage IIIA (N2) Non–Small-Cell Lung Cancer After a Response to Induction Chemotherapy. EORTC 08941 Submitted: May 10, 1999; Revised: Jun. 15, 1999; Accepted: Jun. 10, 2000 Address for correspondence: T.A.W. Splinter, MD, PhD, University Hospital Rotterdam Dijkzigt, PO Box 2040, 3000 CA Rotterdam, The Netherlands Fax: 31-10-4634627; e-mail: vanderhoeven@oncd.azr.nl 1 University Hospital Rotterdam Dijkzigt, Rotterdam, The Netherlands 2 University Hospital Antwerp, Belgium 3 Arnhems Radiotherapeutical Institute, Arnhem, The Netherlands 4 Western General Hospital, Edinburgh, United Kingdom 5 University Hospital Erasme, Brussels, Belgium 6 EORTC Data Center, Brussels, Belgium