Concomitant radiochemotherapy of advanced non-small-cell lung cancer

Concurrent radiochemotherapy (RCT) is a promising new therapy option in adv anced non-small cell lung cancer (NSCLC). In randomized trials concomitant RCT has been shown to be superior compared to radiotherapy alone and to seq uential radiochemotherapy. In most treatment schedules platinum salts alone or in combination with etoposide, mitomycin C or vinca-alkaloids have been used. Up to now altered fractionation schemas-particularly hyperfractionat ed radiotherapy-have not been demonstrated to be superior to conventional f ractionation (2 Gy daily up to 56-60 Gy), when employed concurrently to che motherapy. Nevertheless open questions remain: (1) What is the best chemoth erapy administered simultaneously to radiotherapy? (2) Might newer drugs (e .g. taxanes, inhibitors of topoisomerase I and II, gemcitabine) be more eff ective and reveal fewer side effects compared to platinum salts? (3) Is the re a role for adjuvant chemotherapy following RCT? (4) What is the most eff ective radiotherapy schedule in concepts with RCT? (5) What radiation dose is necessary to optimize local control in RCT? (C) 2001 Elsevier Science Ir eland Ltd. All rights reserved.