Medical treatment for stage III non-small-cell lung cancer (NSCLC)

摘要

Stage III non-small cell lung cancer (NSCLC) comprises a heterogeneous group of diseases with varying prognoses.In addition,the definitions of "resectable" or "unresectable" differ among countries and investigators. Therefore,no clear-cut consensus regarding the management of this disease has been established worldwide as of yet. Single-modality treatments such as chemotherapy, radiotherapy or surgery alone show disappointing results, and therefore combined-modality treatments have been investigated for this disease. Platinum-based combination chemotherapy plus concurrent radiotherapy is one of the standard treatments for good-risk patients with inoperable stage III NSCLC. However, when including new agents for chemoradiotherapy, no optimal treatment has been established. A full dose of chemotherapy including new agents plus concurrent radiotherapy is considered impossible due to excessive toxicity. Consequently, split or reduced doses of chemotherapy are preferred in this setting. On the other hand, postoperative adjuvant chemotherapy, especially platinum-based combination chemotherapy,prolongs survival in patients with completely resected stage III NSCLC. However,the role of the addition of surgery to chemoradiotherapy and the role of molecular-target drugs are still controversial in the management of stage III NSCLC. In the future, many more well-designed clinical trials are warranted to improve the treatment outcome for stage III NSCLC.