Radiation and chemotherapy for patients with stage III non-small cell lung cancer

Nearly 50,000 people in the United States will be diagnosed with stage III non-small cell lung cancer during the year 2000. Over the past 10 years, combined modality therapy has become the standard of care for primary treatment of most of these patients. Numerous studies and meta-analyses document an improvement in survival for patients with stage III disease treated with sequential chemotherapy followed by chest radiation, compared with radiation alone. Some more recent studies have shown a further improvement in survival when the chemotherapy and full-dose radiation are given concurrently. Acute toxicity is increased compared with sequential chemotherapy followed by radiation, but late toxicities seem similar. A current question under study is whether the use of initial chemotherapy followed by concurrent chemoradiotherapy will further improve median and overall survival compared with immediate concurrent therapy alone.