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Lung Cancer. 2014 Feb;83(2):117-25. doi: 10.1016/j.lungcan.2013.11.017. Epub 2013 Dec 1.

How can we optimise concurrent chemoradiotherapy for inoperable stage III non-small cell lung cancer?

Author information

1
Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
2
Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
3
Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom.
4
Pulmonary Oncology Unit, University Hospital of South Manchester, UK.
5
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.

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.

KEYWORDS:

Concurrent chemoradiotherapy; Dose-escalation; Elderly; Inoperable; Non-small cell lung cancer; Radiotherapy

PMID:
24373738
DOI:
10.1016/j.lungcan.2013.11.017
[Indexed for MEDLINE]

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