Stage III: definitive chemoradiotherapy.

Abstract

Concurrent chemoradiotherapy is presently the standard treatment for stage III inoperable non-small cell lung cancer. Within this treatment framework, conventionally fractionated radiotherapy to a total dose of 60-66 Gy has proven effective. The chemotherapy should be performed using a cisplatin-based regimen or, if contraindicated, carboplatin. The base drug can be combined with another cytostatic, such as etoposide, vinorelbine, paclitaxel or gemcitabine. There is no evidence from randomized clinical trials suggesting that addition of induction chemotherapy or adjuvant chemotherapy to the concurrent chemotherapy regimen improves the prognosis of these patients. Therefore, induction or adjuvant chemotherapy should not be used outside the framework of clinical trials. Age over 70 years and concomitant diseases are not contraindications for concurrent radiochemotherapy per se, but an increased rate of side effects can be expected in such elderly patients or patients with comorbidities. Consequently, these patients require intensive supportive care. Presumably, advanced age is not an adverse prognostic factor per se, but reduced heart and lung function are. Conclusive evidence confirming this assumption is lacking.