Chemotherapy and radiotherapy for regionally advanced non-small-cell lung cancer

Treatment of inoperable, regionally advanced non-small-cell lung cancer has been problematic, given the poor long-term results and toxicity of current treatment measures and the extensive comorbid disease commonly found in these predominantly elderly patients. The generally acknowledged standard of care has been administration of radiotherapy to the involved sites and nodal drainage sites. This may improve survival in patients with good prognostic factors. No modality, however, has demonstrated a clear benefit over the others in this setting. Of 13 randomized trials comparing radiotherapy with or without chemotherapy, 5 using non-cisplatin-containing regimens showed no benefit. However, 4 of 6 trials with cisplatin-containing regimens have shown modest benefit. Cisplatin given concurrently with radiotherapy on a daily basis was significantly better than radiotherapy alone and was associated with improved locoregional control, suggesting that the radiation sensitization properties of the drug and consequent local control may be important for enhanced survival. Determining relapse patterns of patients according to these and other treatment approaches may help guide future development of therapeutic options. Improvements in both local and systemic control will be required before a curative approach to treatment can be considered. In this regard, hyperfractionated radiotherapy or radiation sensitizers to enhance locoregional control may complement enhancement of systemic control with chemotherapy, especially if a balance can be struck between the efficacy and toxicity of these modalities.