Non-small-cell lung carcinoma. Current and future therapeutic management.

Non-small-cell lung cancer (NSCLC) is one of the most common malignancies in developed countries and accounts for millions of deaths worldwide. The incidence of NSCLC correlates with smoking tobacco and is likely to increase in those countries with increasing per capita consumption of tobacco. NSCLC is particularly associated with morbidity--in the US several published clinical studies involving a variety of intensive surgical, chemotherapeutic and radiotherapeutic interventions have produced only a 10% 5-year survival. New technologies and breakthroughs in treatment notwithstanding, the current emphasis in clinical trials is to refine and optimise available therapies to maximise patient disease-free and overall survival. These accruing multi-institutional clinical trials may offer surgical resection with or without neoadjuvant therapy, multiagent chemotherapy, and/or standard or hyperfractionated radiation therapy. Since most NSCLC patients have inoperable disease, the most active current trial design entails chemoradiotherapy, since previous trials appear to suggest superior results to radiotherapy alone in these patients.