In addition, chemotherapy could be offered to those
early stage patients with nodal involvement, those with
disease in transplanted lung or remaining native lung
after unilateral lung transplant, or patients with relapsed
disease. Chemotherapy in this group results in higher
rates of response and longer survival compared to those
patients receiving therapy for stage IV disease. However,
median survival in this group is numerically worse than
those with stage I lung cancer in explanted lung, who did
not receive chemotherapy. This difference to some extent
reflects biologic and stage impact of nodal involvement in
chemotherapy-treated group or comorbidities associated
with cancer in remaining native or transplanted lung as
compared to unexpected discovery of cancer in explanted
lung without nodal involvement. It is also possible that
some of the survival differences could be attributed to
adverse events from chemotherapy, and particularly sepsis
secondary to profound bone marrow suppression in this
already immune-compromised population.