[Radiochemotherapy and radiosensitization for locally advanced non-small-cell bronchial cancer]

Combined chemotherapy and radiotherapy can improve the survival of patients with locally advanced non-small cell lung cancer, when compared to irradiation alone. This survival benefit is essentially due to an increased control of distant micrometastases, whereas local control remains poor. In order to improve local control, new radiotherapy modalities such as 3D conformal treatment, hyperfractionation or accelerated hyperfractionation, are under development. Cytotoxic drugs given at low doses concomitantly to radiotherapy may act as radiosensitizers on the primary tumor. Concomitant chemotherapy at cytotoxic doses and radiotherapy would also allow better control on micrometastases and better local control due to radiosensitization by chemotherapy. However, the concomitant use of chemotherapy and radiotherapy is limited by increased toxicity on normal tissues, more particularly on the esophagus. Randomized comparisons of these modalities versus induction chemotherapy followed by radiotherapy are needed to determine the optimal treatment sequence.