[The big dilemma: the chemotherapy of non-small cell lung carcinoma]

The most problematic area in pulmonary oncology is the chemotherapy of non-small cell lung carcinoma and its place in the therapeutic strategy. Chemotherapy based on the earlier alkylating agents worsened survival of NSCLC patients. That was the reason for the nihilistic approach by many colleagues toward chemotherapy in NSCLC. Today this question has been resolved. Platinum based combined chemotherapy significantly prolongs survival and improves quality of life. Other possibilities are to incorporate the new chemotherapeutic agents (taxanes, Gemcitabine, Vinorelbine, Irinotecan) into the chemotherapeutic regimens. These agents improve the response rate and the quality of life and can be safely administered in outpatient bases, although in comparison to the earlier agents the survival gain is moderate. In early stages the role of adjuvant chemotherapy is questionable. Chemotherapy, surgery and postoperative irradiation may all have a role in the case of N2 disease.In locally advanced disease the use of radiochemotherapy is recommended. In advanced NSCLC chemotherapy is suggested in good performance status. The author summarises the role of chemotherapy in NSCLC, based on literature and on his own experience.