Combined chemotherapy and radiation therapy in surgically unresectable regionally advanced non-small cell lung cancer

There have been increasing reports suggesting that combined treatment modality is superior to one modality approach in regard to median and 2-year survivals, and local control for patients with locally advanced unresectable (stage III) non-small cell lung cancer. However, there are five major issues to be discussed before the above conclusion will be drawn. First, the staging system for lung cancer is not perfect and extent of metastatic workup is controversial for patients with locally advanced unresectable non-small cell lung cancer. It is difficult to compare studies which have not mentioned the proportion of stage IIIA to stage IIIB nor completeness of staging workup. The second controversial area is selection of patients to be treated by combined modality. Third, definition of unresectability changes depending on the surgeon's aggressiveness, skills, experience, and back-up system, including other speciality groups and facilities as well as the patient's willingness and physical fitness. Fourth, optimal sequences of combined modalities are still under investigation. Finally, rates of toxicity of the combined modality need to be reported as well as efficacy of treatment.