[Neoadjuvant chemotherapy and chemoradiotherapy in locally advanced stage IIIA and IIIB of non-small-cell bronchial carcinoma (the Essen concept)].

Induction chemotherapies followed by concurrent chemoradiotherapy and definitive surgery have been tested in Essen since 1991 in a large phase-II study for patients with locally (far) advanced non-small cell lung cancer (NSCLC) stages IIIA (N2) and IIIB (T4, N3). After a median follow-up time of 43 months, mature long-term survival data for this intensive multimodality treatment program can now be reported. With nearly 1/3 of these patients experiencing long-term survival at 4 and 5 years after this approach, a significant improvement of long-term prognosis seems to have been achieved, because retrospective comparisons have demonstrated a rather unfavourable prognosis for these disease stages. However, new standards in the treatment for these disease stages could only be defined in the setting of national or international phase-III trials. Based on these promising results, a prospective randomized phase-III study has been planned for patients with stage IIIA (N2) as well as for centrally far advanced T3-tumors and one year ago patient accrual for this study has been started oligoinstitutionally. The standard arm of this study consists of upfront surgery followed by adjuvant radiation therapy, whereas for the experimental arm our Essen protocol a combination of induction chemotherapy with concurrent chemoradiation followed by surgery has been chosen. Meanwhile this prospective randomized trial has gained national support by the "Deutsche Krebshilfe". For stage IIIB (excluding patients with malignant pleural effusion or supraclavicular nodes) a further prospective randomized trial is on its way testing chemotherapy followed by a definitive concurrent chemoradiation approach up to 65 Gy radiation dose versus a multimodality program similar to our phase-II protocol with the inclusion of definitive surgery. Smaller phase-I and -II trials will search for alternative possibilities to improve the induction protocol first of all by the inclusion of new active drugs and secondly by increasing the chemotherapeutic dose intensity of the substances used so far. Due to the promising long-term results of the multimodality treatment programs published so far, these unfavourable patients with locally advanced NSCLC have now gained particular interest due to the development of now curatively intended treatment approaches.