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

Although mortality of lung cancer in men among the countries of the European Union is steadily decreasing, there is still an increasing mortality among women, and as a consequence the overall rate of lung cancer-related deaths has not been declining in Europe [1, 2]. Thus, the development of optimized treatment approaches in lung cancer patients remains an urgent issue. Today, non-small-cell lung cancer (NSCLC) histopathologies represent the vast majority, representing >85% of all lung cancer patients [3]. Stage III NSCLC, the locally advanced tumor stage, has offered the best chances for possible therapeutic innovations and improvements by the introduction of interdisciplinary, combined modality treatment strategies [4, 5]. With systemic relapses being a major problem in this patient subgroup, combination chemotherapy has emerged as an integral part of the overall treatment management [6, 7]. Combinations of radiotherapy and platinum-based chemotherapy have consequently been proposed as standard of care for the vast majority of these patients in stage III [5, 7, 8]. Surgery plays a generally accepted role in only a small group of patients with minimal or operable (‘surgical’) stage III disease [6, 8–10]. In 2000, we reviewed the literature for a comprehensive overview on combined modality treatment of NSCLC [11]. In the following paper, we will give a short update on important new developments since the year 2000 in multidisciplinary treatment approaches, including both combination chemotherapy and radiotherapy. Special focus has been on newer drug combinations in this setting, innovations in radiotherapy application and concurrent treatment protocols. New findings dealing with the overall role of surgery in this setting will be critically discussed.