48. Combined chemotherapy and radiation in locally advanced NSCLC

In locally advanced inoperable NSCLC radiotherapy has traditionally been considered the mainstay of treatment. Unfortunately, in most instances this method does not allow for eradication of bulky tumor in the thorax and does not prevent uncontrolled systemic disease. In consequence the prognosis of these patients is dismal and has remained essentially unchanged within the last decades. The five-year survival rates after irradiation varies between 3 and 10%. During the last decades several approaches have been tested to improve this outcome. Of those, particular attention has focused on combining chemotherapy and radiation. Two most frequently used strategies have included induction chemotherapy followed by radiation, or concurrent chemoradiation. The results of a few phase III trials comparing radiation alone with radiation supplemented by chemotherapy have demonstrated modest yet significant survival benefit from the combined approach. Two recent studies suggested that concomitant chemoradiation might be more effective than chemotherapy preceding radiation. The gain from the concurrent use of both modalities should however be weighted against increased toxicity. Further studies built upon recent positive results should focus on identifying means of optimal interactions between the two modalities. This research should define the most effective types and doses of anticancer agents as well as the optimal features of radiotherapy