title: How can we optimise concurrent chemoradiotherapy for inoperable stage III non-small cell lung cancer?
abstract: Latest evidence sets a clear mandate for concurrent chemoradiotherapy as the current standard of care for inoperable stage III non small cell lung cancer patients with good performance status and minimal co-morbidities. However, a survival plateau has been reached, with disappointing results from dose escalation studies using conventional fractionation and studies investigating the addition of systemic doses of chemotherapy delivered before or after concurrent chemoradiotherapy. A review was carried out to address three questions considered fundamental to improving outcome in patients with stage III non-small cell lung cancer: (1) Can radiotherapy regimens be optimised using advanced radiotherapy techniques to improve local control rate and overall survival? (2) Can systemic therapy regimens be optimised to reduce the risk of distant metastases? (3) Should concurrent chemoradiotherapy be considered standard of care for locally advanced non-small cell lung cancer in the elderly? It is clear that further improvement in outcome for these patients will be determined by better local control and by reducing the risk of distant recurrence. Given the technological advances in radiotherapy planning and delivery in recent years plus the abundance of novel targeted therapies exploiting critical oncogenic pathways, further advances in combined drug-radiation treatment for lung cancer seem highly possible.
authors.affiliation: Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Bayman
authors.affiliation: Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Blackhall
authors.affiliation: Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Paula
authors.initials: P
authors.lastname: McCloskey
authors.affiliation: Pulmonary Oncology Unit, University Hospital of South Manchester, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Taylor
authors.affiliation: Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom. Electronic address: corinne.finn@christie.nhs.uk.
authors.forename: Corinne
authors.initials: C
authors.lastname: Faivre-Finn
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D009364:Neoplasm Recurrence, Local; D058996:Quality Improvement
keywords: Concurrent chemoradiotherapy; Dose-escalation; Elderly; Inoperable; Non-small cell lung cancer; Radiotherapy