title: Radical Radiotherapy for Locally Advanced Non-small Cell Lung Cancer: When Should Concurrent Chemoradiotherapy Not Be Used?
abstract: Concurrent chemotherapy and radiotherapy confers a significant, but small, benefit for overall survival compared with sequential chemoradiotherapy. The improvement of about 4% with a hazard ratio of 0.85 has only been proven for fit patients with a good organ function. From non-randomised trials, there are no indications that concurrent chemoradiotherapy is clearly superior to the sequential approach in other patients. Moreover, radiotherapy alone can lead to 5 year survival rates of 20%. As the differences in long-term survival between the treatment options are small, even fit patients should be offered, via a shared decision process, the choice between concurrent and non-concurrent chemotherapy and radiotherapy. In less fit patients, sequential chemoradiotherapy offers a chance for long-term survival and cure with less toxicity than the concurrent approach.
authors: Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Maastricht, The Netherlands; KU Leuven, Radiation Oncology, Leuven, Belgium. Electronic address: dirk.deruysscher@maastro.nl.
authors: D
authors: D
authors: De Ruysscher
authors: Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Maastricht, The Netherlands.
authors: J
authors: J
authors: van Loon
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000401:mortality* / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D011379:Prognosis; D011878:Radiotherapy / Q000401:mortality*; D015996:Survival Rate
keywords: Combined modality treatment; concurrent; elderly; frail; non-small cell lung cancer; sequential