Abstract
In 1990, the CALGB 8433 study showed that survival was improved by sequential platinum-based chemotherapy followed by radiotherapy (CT → RT) when compared with radiotherapy alone for unresectable stage III non-small cell lung cancer (NSCLC). In 1998, the West Japan Oncology Group first reported that survival was significantly prolonged by concurrent chemoradiotherapy (CT+RT) compared with CT → 12T. This superiority of CT+RT was reconfirmed by RTOG in 2000. Therefore, platinum-based CT+RT is now considered the most effective therapy for patients with unresectable stage III NSCLC who have a good PS, adequate lung function and are without pleural effusion. Recently, the new agents of paclitaxel, docetaxel, vinorelbine, irinotecan and gemcitabine have been employed in clinical practice for treatment of NSCLC. Up to now, no phase III study has confirmed which is the best agent for concurrent radiotherapy. However, a new agent in combination with concurrent radiotherapy at a high dose offers the possibility for success, and a platinum-based paclitaxel or docetaxel shows promise in CT+RT. In the near future, since the new oral fluoropyrimidine, S-1, and a selective inhibitor of EGFR tyrosine kinase, gefitinib, have radiosensitizing effects, each of these drugs will be investigated in combination with concurrent radiotherapy. In terms of radiation technique, altered fractionation schemas, particularly hyperfractionated radiotherapy, have not been demonstrated to be superior to conventional fractionation (2 Gy daily up to 56-60 Gy) when employed concurrently with chemotherapy. To reduce radiation-field of the normal lung, state-of-the-art 3D conformal radiation techniques or the proton radiation should be investigated.
