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Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1812
Dipartimento di Fisiopatologia Clinica, Università degli Studi di Torino, Torino
At the time of initial diagnosis, approximately 50% of patients with non-small cell lung cancer (NSCLC) have clinically detectable metastatic spread outside the chest, and locally advanced unresectable thoracic tumors are found in a further 10-15% of patients. Furthermore, more than 50% of the remaining patients recur either locally or at distant metastatic sites after surgery. This means that more than three-quarters of patients with NSCLC are potential candidates for systemic chemotherapy alone or with radiotherapy at some time during the course of their disease. Following overall chemotherapic treatment, complete response rates are strongly correlated with stage (stage III, 39% stage IV, 25%). Response rates were significantly higher for combination chemotherapy than for single-agent treatment. Response rates in NSCLC are higher when combination chemotherapy is used compared with single-agent treatment. Comparing single-agent therapy to combined therapy we find a consistent improvement in survival when polychemotherapy is employed. As far as adjuvant chemotherapy after surgical resection is concerned, the most active regimens in use today result at best, in response in only 35-50% of patients with advanced disease, and complete clinical responses are rare. Several trials were performed in the early 1980s and 1990s to determine whether the sequential administration of combination chemotherapy followed by thoracic radiotherapy could prolong survival for patients with locally advanced NSCLC. No or minimal survival benefit was seen at three years and five years in most of the studies. The value of adding chemotherapy to thoracic irradiation is still controversial today. All the studies showed improvements in both median and two years survivals, but this was not always accompanied by prolongation of long-term survival or increased cure rates. Although radiation with or without chemotherapy is standard therapy for patients with unresectable locally advanced tumors, there has been recent interest in treatment programs of chemotherapy followed by surgery. Response to chemotherapy may allow an otherwise-unresectable tumor to be surgically resected. However, this should not be viewed as the primary goal of treatment, since other treatment modalities can achieve local control and most patients die of distant failure. The indications for external-beam radiation include medically inoperable lung cancer, regionally advanced lung cancer where surgical resection is not feasible, and as a palliative tool in patients with advanced disease. Combination chemotherapy and radiation therapy has been utilized as a method to increase aggressive non-surgical treatment in regionally advanced lung cancer. It remains unclear as to which chemotherapeutic agents are best and as to the most appropriate timing of irradiation and chemotherapy.