Current strategies for locoregionally advanced unresectable non-small cell lung cancer

Locoregionally advanced unresectable non-small cell lung cancer is defined by bulky primary site disease and/or regionally advanced lymphadenopathy involving the contralateral mediastinum and/or supraclavicular lymph nodes. These tumors are not amenable to curative-intent surgical resection but can be approached with curative-intent radiation therapy. It is clear, however, that when exposed to radiation therapy as a single treatment modality, the majority of patients will develop systemic disease progression, indicating the presence of systemic micrometastases at the time of initial diagnosis. It also has been demonstrated that a large percentage of patients will develop locoregional disease progression. The latter indicates the inability of standard fractionation radiation therapy to successfully eradicate the disease within the radiated field. It can be concluded that to truly eradicate the disease and achieve cure, more successful locoregional and systemic therapy has to be administered. The integration of chemotherapy with radiation therapy has been pursued in clinical trials over the last 20 years and is reviewed. The results of phase II trials investigating weekly administration of carboplatin, paclitaxel, and radiation therapy have been encouraging. Confirmation of their findings in the large cooperative group setting will be necessary.