Evolving chemoradiation treatment strategies for locally advanced non-small-cell lung cancer

Survival for patients with stage III non-small-cell lung cancer has gradually improved in recent years, with median survival times increasing from less than 10 months to more than 18 months. These increases are thought to result primarily from advances in chemoradiation. This article reviews major advances in the development of chemoradiation for patients with locally advanced non-small-cell lung cancer. Results from cooperative group trials suggest that concurrent chemoradiation is superior to sequential therapy and may replace sequential therapy as the new standard of care in patients with good performance status. Technological advances such as 18F-fluorodeoxyglucose positron emission tomography (PET) staging can be used to improve patient selection and predict survival. Locoregional control may be improved by altering radiation fractionation or delivery (e.g., hyperfractionation, high-dose involved-volume radiotherapy, 3D conformal radiotherapy). Novel agents and regimens in combination with radiation are being investigated to further improve therapeutic outcomes.