Concomitant radiochemotherapy of advanced non-small-cell lung cancer

Concurrent radiochemotherapy (RCT) is a promising new therapy option in advanced non-small cell lung cancer (NSCLC). In randomized trials concomitant RCT has been shown to be superior compared to radiotherapy alone and to sequential radiochemotherapy. In most treatment schedules platinum salts alone or in combination with etoposide, mitomycin C or vinca-alkaloids have been used. Up to now altered fractionation schemas-particularly hyperfractionated radiotherapy-have not been demonstrated to be superior to conventional fractionation (2 Gy daily up to 56-60 Gy), when employed concurrently to chemotherapy. Nevertheless open questions remain: (1) What is the best chemotherapy administered simultaneously to radiotherapy? (2) Might newer drugs (e.g. taxanes, inhibitors of topoisomerase I and II, gemcitabine) be more effective and reveal fewer side effects compared to platinum salts? (3) Is there a role for adjuvant chemotherapy following RCT? (4) What is the most effective radiotherapy schedule in concepts with RCT? (5) What radiation dose is necessary to optimize local control in RCT?