The evolving role of radiation therapy in the treatment of locally advanced lung cancer.
RT has been used routinely in the treatment of NSCLC and SCLC for the past several decades. Although largely considered a palliative treatment by most oncologists, there is increasing evidence that RT, when combined with cisplatin-based chemotherapy or given by altered fractionation, may improve the survival in NSCLC. Three large randomized trials have now shown that RT plus a cisplatin-based combination or cisplatin alone prolongs patient survival. Studies of hyperfractionation and accelerated hyperfractionation have also shown promise and are being tested in randomized trials worldwide. The results from these trials must be assessed against ongoing radiation dose escalation studies using new treatment planning technologies, albeit still in their infancy. These trials are discussed in this report. Systemic therapy is the cornerstone of treatment for SCLC. Although the value of RT was hotly debated during the 1970s and 1980s, it is now well established that RT improves survival when combined with chemotherapy in limited stage patients. Despite this advancement, other issues (such as timing or sequencing of modalities, radiation dose, fractionation, and treatment volume), remain unsettled. Randomized trials designed to address these important issues are in progress.
Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor.
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D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy; D018288:Carcinoma, Small Cell / Q000532:radiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage
D000970:Antineoplastic Agents; D002945:Cisplatin