J Lung Cancer.  2006 Jun;5(1):1-16. 10.6058/jlc.2006.5.1.1.

Current Update on the Management of Locally Advanced Non-small Cell Lung Cancer

• Chang B
• Park C
• Choy H

• KMID: 1881520
• DOI: http://doi.org/10.6058/jlc.2006.5.1.1

Abstract

Locally advanced NSCLC is a heterogenous group of bronchogenic malignancies that are traditionally thought to be unresectable without overt distant metastasis or malignant pleural effusion. The mainstay of treatment for this class of diseases until the early 1990s was radiation alone, which resulted in a dismal outcome. The new technologies in radiation therapy (e.g. 3D-CRT) and the shift in paradigm (e.g. omission of ENI) have enabled the dose-escalation, which translated to improved outcome compared to the conventional radiotherapy using 2-D planning. The trials combining chemotherapy with radiotherapy, first sequentially, then concurrently, have changed the standard of care for patients with good functional status to concurrent chemoradiation. Some studies have shown survival benefits to adding consolidative systemic therapy with concurrent chemoradiation. We will outline the development of the current treatment standard of locally advanced NSCLC and present selected topics undergoing active research to forecast the next generation of NSCLC therapy

MeSH Terms

Carcinoma, Non-Small-Cell Lung*
Drug Therapy
Humans
Neoplasm Metastasis
Pleural Effusion, Malignant
Radiotherapy
Standard of Care

Figure

• 

  Fig. 1. Three-dimensional treatment plan, (A) Coronal section through isᄋcenter of a typical three-dimensional treatment plan isᄋdose distribution. (B) Axial section at 3.5 cm superior to isocenter for the same patient. The planning target volume is outlined in yellow. The patient had T3 NO norismal! cell lung cancer based on disease extension into the right mainstem bronchus. Based on these isodose distributions, the doses were estimated as follows; subcarina, 8,000 cGyæ ispsilateral inferior mediastinum. 4,000 cGy: contralateral inferior mediastinum, 1,000 cGy: superior mediastinum and supraclavicular region 0 Gy.

• 

  Fig. 2. Compared 2-dimensional radiation treatment planning and 3-dimensiᄋnal radiation treatment planning.

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  Fig. 3. Tumor is moving by respiration.

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