Multimodality therapy for non-small-cell lung cancer.

The optimal treatment strategy for patients with locally advanced (stage III) non-small-cell lung cancer remains controversial. Primary surgical resection or conventional thoracic irradiation alone results in poor long-term survival for the majority of stage III patients. Several multimodality strategies are reviewed in this article. Radiation followed by surgery may increase resectability, but its effects on survival are unproven. Sequential chemotherapy and radiation have demonstrated a survival advantage for selected stage III patients. Chemotherapy followed by surgery has also shown encouraging results, and additional studies are in progress. Concurrent chemoradiotherapy has shown conflicting results in a few randomized studies. Concurrent chemotherapy and radiation followed by surgery has been tested only in phase II trials and awaits further studies.