Sequencing chemotherapy, radiotherapy and surgery in combined modality treatment of stage III nonsmall cell lung cancer.
OBJECTIVE
Combined modality treatment is nowadays the standard of care in stage III nonsmall cell lung cancer, but the overall survival is still poor. Therefore, the challenge for clinicians is to optimize the combination of the treatment modalities. The review will focus on bimodality and trimodality approaches in stage III nonsmall cell lung cancer. Although the role of surgical resection in combined modality treatment is unclear, surgery will be discussed as a potential part of the treatment approach.


RESULTS
Concurrent chemoradiotherapy has proven to be more effective than chemotherapy followed by radiotherapy. Full-dose consolidation chemotherapy after concurrent chemoradiation showed an improvement of survival in some studies. Consolidation chemotherapy is, however, difficult to administer owing to its toxicity in these complex regimens. Both the Eastern Cooperative Oncology Group and the Radiation Therapy Oncology Group showed similar survival after surgery compared to sequential or concurrent chemoradiotherapy; however, pneumonectomies and residual malignant mediastinal disease after induction treatment had a negative impact on survival.


CONCLUSIONS
Concurrent chemoradiotherapy in combination with full-dose chemotherapy should be the standard of care for nonsmall cell lung cancer stage IIIA/B. Surgery is still experimental, but seems to be promising for certain subgroups of patients. More research has to be done in optimizing radiotherapy schedules and chemotherapy schemes in order to minimize toxicity. Novel therapeutics have to be introduced in the combined modality approach of stage III nonsmall cell lung cancer.
Maas
Klaartje W
KW
Department of Pulmonary Diseases, St Antonius Hospital, Nieuwegein, The Netherlands.
El Sharouni
Sherif Y
SY
Smit
Egbert F
EF
Schramel
Franz M N H
FM
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D016896:Treatment Outcome
D000970:Antineoplastic Agents