Locally advanced, unresectable non-small cell lung cancer: new treatment strategies

Approximately 40% of non-small cell lung cancer (NSCLC) patients present with locally advanced, unresectable lesions. Treatment with thoracic radiotherapy yields survivals averaging just 9 to 10 months, and long-term survival at 5 years is poor. Recent studies indicate that chemotherapy followed by thoracic radiotherapy improves 5-year survival by three- to fourfold. Nevertheless, most patients do ultimately die of the underlying disease. New strategies designed to enhance local tumor control-use of radiation-sensitizing drugs, three-dimensional treatment planning techniques, or altered radiation fractionation schedules-may further improve survival outcome. In addition, newer cisplatin-based regimens containing either paclitaxel or vinorelbine improve survival over that achieved with older vinca alkaloid or podophyllotoxin combination regimens. Accordingly, the newer drug regimens combined with radiotherapy can be expected to further improve survival in this subset of NSCLC patients. Prospective studies are underway to test this conjecture.