Multimodal therapy in locally advanced NSCLC

Patients with locally advanced non-small cell lung cancer (stage IIIB, inoperable stage IIIA) require multimodal therapy. This stage is diagnosed in about one-third of patients suffering from lung cancer. Rarely can tumour resection be undertaken after primary induction chemotherapy, and in most cases systemic therapy is administered. A combination of radiation and chemotherapy should be the goal if performance status and comorbidities are not prohibitive. Considering long-term survival, simultaneous radiochemotherapy seems to be beneficial compared to sequential radiochemotherapy. However there is elevated toxicity after concomitant therapy. Recently, the alternative concept of primary induction chemotherapy and subsequent combined radiochemotherapy with reduced doses of cytostatic drugs showed first positive results and less toxicity. Chemotherapeutic drugs of first choice are platinum combinations. There is evidence of better outcome after hyperfractionated radiation instead of standard radiation. The benefit of adjuvant chemotherapy in locally advanced NSCLC after surgical resection seems to be given, but requires further confirmatory data and details.