Use of chemo-radiotherapy in locally advanced non-small cell lung cancer

Lung cancer is the leading cause of cancer mortality in the Western countries for both men and women. Approximately 40% of patients present with locally advanced and/or unresectable disease. While small improvements in outcome have occurred for this group of patients in the last decade, 5-year survival remains low, ranging from 5 to 20%. Distant metastases and loco-regional progression remain significant patterns of failure. Up to the late 1980s, the standard management for locally advanced non-small cell lung cancer (NSCLC) was conventional thoracic radiotherapy, but when treated with radiotherapy alone, less than 10% of patients survived for 5 years or more. 60-70% failed at distant sites and less than 20% achieved durable local control. The addition of chemotherapy reduces the rate of distant failure, improves survival and the combination of chemotherapy and radiotherapy has become the standard of care of patients with locally advanced NSCLC. Current developments aim to optimise individual components of combined modality schedules, increase their synergism and minimise toxicity.