Early resection of lung cancers confined to the chest remains the best means of curing patients. Nonetheless, cure rates for resected patients are less than 50% overall, primarily due to the presence of occult distant metastases at the time of resection that subsequently manifest as relapse at distant sites. In approximately 20% of patients, local failure occurs within the chest. Chest radiotherapy reduces and nearly eliminates local failure, but does not improve survival or cure rates. Effective systemic chemotherapy is the cornerstone to improving survival and cure rates for early stage lung cancer. Recent studies showed that the preoperative use of cisplatin-based chemotherapy improved survival and 3-year disease-free survival in stage IIIA non-small cell lung cancer. New drugs such as paclitaxel and gemcitabine appear to improve survival in stages IIIB and IV non-small cell lung cancer. These agents will be tested in the surgical setting in the near future.