Optimizing chemoradiation therapy approaches to unresectable stage III non--small cell lung cancer

There have been important recent advances in the management of inoperable non--small cell lung cancer. Concurrent cisplatinum-or carboplatin-based chemotherapy and 60 to 64 Gy of thoracic radiation therapy has replaced sequential therapy as the new standard therapy for good-risk patients. New agents such as docetaxel, gemcitabine, and irinotecan are being tested to replace the standard chemotherapy given during thoracic radiation. Phase II studies of induction or consolidation chemotherapy have also shown promise but these agents have not yet been proven to improve outcome in a prospective randomized study. New strategies for optimizing thoracic radiation, primarily by dose escalation with three-dimensional conformal technique, have also led to an improved therapeutic ratio. Alternative strategies may be required for poor-risk, elderly patients.