The role of chemoradiotherapy in the treatment of stage III non-small-cell lung cancer

Any therapeutic management of patients with stage III NSCLC has to take into account the marked prognostic heterogeneity and the individual comorbidity profiles within these patient groups. Unfortunately, only a few prospectively randomized investigations have been reported within recent years that may have an influence on evidence-based treatment guidelines. Therefore, within this time period, only a few general principles of care could be established for the interdisciplinary approach to these patients: (i) a combination of chemotherapy and radiotherapy should be the minimum requirement of management; (ii) concurrent application of chemotherapy and radiation therapy is accepted as an optimal therapeutic strategy and should be the first choice in patients with good performance status and an adequate comorbidity profile, unless contraindications to these more toxic protocols exist; (iii) inclusion of chemotherapy into any combined modality protocol for stage III is generally advisable; (iv) surgery as part of an interdisciplinary treatment protocol is standard of care in the small subset of patients with initially operable stage III; (v) surgery following induction therapy is possible in experienced hands/treatment groups, but its overall role still is debatable and not definitely accepted in patients with initially inoperable stage III; (vi) radiation doses, conformal application of radiation and optimal fractionation schemas are as yet not well defined; (vii) optimal chemotherapy combinations are not well defined; (viii) administration of complex bimodality or trimodality treatment protocols requires dedicated, experienced and functioning multidisciplinary treatment teams to guarantee high quality of care as well as an adequate handling of side-effects; and (ix) no molecular prognostic factor has up to now been established for these locally advanced stage subsets. Further results of important phase III trials in stage III are awaited and may influence our treatment strategies and portfolio in the future. © 2004 European Society for Medical Oncology.