THERAPEUTIC OPTIONS AND INNOVATIVE APPROACHES IN INOPERABLE LOCALLY ADVANCED NON-SMALL-CELL LUNG-CANCER (STAGE IIIB)

Treatment of patients with inoperable locally advanced nan small-cell lung cancer (NSCLC) remains disappointing with less of 5% of patients alive at 5 years. Both initial local control and circumvention of conc omitant undetectable metastatic chemoresistant cells are the critical targets for the oncologists in charge of this disease Results of a rec ent metaanalysis including 22 randomized studies comparing standard tr eatment (i.e. radiotherapy) to sequential chemoradiotherapy have undou btabely well defined the role of cisplatine-containing chemotherapy in stage IIIB NSCLC, even if the 5 year survival benefit remains modest. However high complete response rates and prolonged overall survival w ere observed with combinations of new promising chemotherapy regimens and new fractionated radiation schedules in several phase II studies. These results have to be corroborated by prospective randomized trials . Integration of more aggressive and more toxic strategies such as rad ical surgery in these initial inope- rable locally advanced NSCLC are evaluating Around these conventional therapies, the stage IIIB NSCLC r epresent a Savoured target to elaborate innovative therapeutic approac hes bared on emergence of biotherapies as recombinant cytokines, antit umoral vaccine and gene therapy programs The contribution of these new therapeutic options opens new directions in the therapeutic strategy and leads to hope a new promising era in the management and outcome of patients with these tumors.