Chemotherapy and radiation for the treatment of non-small-cell lung cancer. A critical review.
Lung cancer remains the most common fatal malignancy, so even modest therapeutic advances are potentially beneficial to large numbers of patients. For patients with regional nodal metastases identified at thoracotomy, adjuvant chemotherapy may be of benefit and additional clinical trials are in progress. Locally advanced disease is present in over a third of patients at diagnosis. For patients with marginally resectable tumors, the preliminary results of the neoadjuvant chemotherapy trials are encouraging and may result in an improvement in the 15% 5-year survival in this group. For patients with locally advanced and unresectable tumors, several but not all studies suggest that the combination of chemotherapy and radiation produces better results than radiation alone. Additional trials are needed to clarify these results. In addition, better methods are needed to maintain local control of unresected tumors. Hyperfractionated radiation schedules and concurrent administration of radiosensitizing chemotherapy drugs appear to be the most promising leads. Effective systemic treatment for patients with disseminated disease remains elusive. Several new classes of drugs, especially taxol and the topoisomerase I poisons, are being introduced and have rekindled hope for improved treatment of this large group of patients.
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
J R
JR
Murren
A C
AC
Buzaid
D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D015996:Survival Rate