Nonsurgical management of non-small-cell lung cancer

Aggressively applied radiotherapy can cure approximately 15% to 20% of medically inoperable patients. It is hoped that with more sophisticated treatment planning and more dose-intensive radiation, the results in these tumors can be improved. No good clinical evidence to date suggests that including areas of subclinical involvement will result in higher cure rates. In patients who have regionally advanced disease, combination therapy consisting of concurrent chemotherapy and irradiation seems to have yielded an improvement in short-term and median survival. Patients selected for this type of aggressive treatment must have a good performance status and should be less than 70 years of age. Refinements in chemotherapeutic agents, in the delivery of radiotherapy, and in the interdigitation of these modalities are areas of intense clinical research.