Combined modality therapy of non-small cell lung cancers

Lung cancer represents the leading cause of cancer mortality. Nonsmall cell lung cancer (NSCLC) accounts for about 75% to 80% of lung cancer cases and carries a 5-year survival of about 10% to 15% for all stages. Approximatel y one-third of NSCLC patients present with stage III disease, which is defi ned as locally advanced tumour confined to the chest without distant metast asis. The traditional treatment for stage III patients has been thoracic ra diotherapy (RT). However, the impact of thoracic RT alone has been minimal with published studies showing median survival <1 year and 5-year survival of 5% to 7%. Thus, the treatment of stage III NSCLC remains a significant c hallenge. The metastatic nature of this disease has been responsible for th e poor survival statistics and emphasises the need for effective systemic t reatment. In recent years, cisplatin-containing combination chemotherapy ha s emerged as a viable option in the treatment of NSCLC. Combined modality t herapy employing systemic (chemotherapy) and local (RT with or without surg ery) approaches has shown favourable results in patients with stage III dis ease. Randomised studies have demonstrated the benefit of concurrent or seq uential chemoradiation in selected patients with a good performance status and minimal weight loss. The exact sequence has yet to be determined, Moreo ver, randomised studies in stage IIIA potentially resectable disease show s urvival advantage for patients receiving combined modality treatment. Thus, combined modality treatment has the potential to improve overall survival by increasing both local and distal control. These recent reports of random ised clinical trials of combined modality therapy for stage III NSCLC form the basis for this report. Several new agents, like the taxanes, CPT-11 and gemcitabine show promising activity in NSCLC treatment. Ongoing studies ar e evaluating the potential role of these new agents in combined modality tr eatment but since the phase III trials have not been reported yet these stu dies will not be discussed.