Table of Contents
Chemotherapy Research and Practice
Volume 2010 (2010), Article ID 506047, 5 pages
http://dx.doi.org/10.1155/2010/506047
Review Article

From Cisplatin-Containing Sequential Radiochemotherapy towards Concurrent Treatment for Patients with Inoperable Locoregional Non-Small Cell Lung Cancer: Still Unanswered Questions

1Department of Radiation Oncology, Academic Medical Center (AMC), University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
2Department of Radiation Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands

Received 10 August 2010; Revised 18 November 2010; Accepted 25 November 2010

Academic Editor: Vito Lorusso

Copyright © 2010 C. C. E. Koning et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Radiotherapy has been the mainstay of the treatment of stage III non-small cell lung cancer (NSCLC) patients. In the early nineties, combined treatment with chemotherapy was introduced. In 1995, a meta-analysis showed improved treatment outcome of the sequential use of radiochemotherapy (RCT) compared to radiotherapy alone, provided cisplatin was part of the chemotherapy course. Concurrent RCT compared to radiotherapy only yielded the same improvements of 4% in the 2-year and 2% in the 5-year overall survival rates. Just recently, two meta-analyses demonstrated that concurrent RCT is definitely superior to sequential RCT in terms of local control and 2-, 3-, and 5-year survival. However, several unanswered questions remain concerning the optimal chemotherapy regimen and radiotherapy doses and techniques in terms of treatment outcome and toxicity profile. Arguments supporting a daily low-dose cisplatin scheme are presented because of comparable radiosensitizing characteristics and favourable side effects. Increasing radiotherapy doses applied according to up-to-date techniques and combinations with new biologicals might lead to further treatment improvements.